Utilization Review Manager
Resume:
Ebony J. Anderson, RN-BSN
Richmond, Virginia 23228
**************@***.***
Objective Seeking a challenging position where my medical,
professional, and practical experience will be fully
utilized.
Profile Goal-oriented with strong leadership capabilities.
Organized, highly motivated, and detail-directed problem
solver.
Proven ability to work in unison within a multidisciplinary
team.
Possess strong oral, written, and interpersonal communication
skills.
Clinical background in telemetry/medical-surgical nursing and
long term care.
Education Bachelor of Nursing Science, Virginia Commonwealth University
08/10-12/11
Associate Degree in Nursing, J. Sargeant Reynolds Community
College 08/05-12/07
Vocational Diploma, Richmond School of Health and Technology
09/01-06/03
High School Diploma, Varina High School
09/94-05/98
Relevant Experience & Accomplishments
Pre-authorization Coordinator
McKesson InterQual certified.
Service 65/80 reviews per day.
Implement and document utilization activities.
Offer safe, effective alternatives to inpatient stays to
members requiring intervention.
Utilize established criteria to authorize inpatient
admissions, diagnostic testing, and transplant services.
Responsible for making sure members are provided healthcare
services that are medically necessary, appropriate, and cost
effective.
Clinical Knowledge
Telemetry
Long term care
EKG monitoring
Critical Care concepts
Pre and post-operative cardiac care
Employment Case Manager, Mary Washington Healthcare, 04/13-Presen
Fredericksburg VA t
Perform initial level of care and concurrent
reviews using medical necessity criteria.
Utilize Soarian to collect clinical data needed
to assess and evaluate patient needs.
Document assessments, referrals, and overall
discharge plans in Midas.
Refer all cases that do not meet medical 09/09-Presen
necessity to the physician advisor for second t
level review.
Team Lead Utilization Reviewer, KePro, Richmond
VA
. Analyze patient records to determine the
legitimacy of admission and treatment provided
by a health-care facility in order to comply
with government reimbursement policies.
. Review applications for in-patient admissions 04/12-12/12
and either approve or refer cases to the
utilization review committee when a case fails
to meet admission standards.
. Assist in the coordination of the day-to-day
assignment of work and monitoring of
productivity.
Clinical Nurse-RN, Ashland Convalescent
Rehabilitation Center, Ashland VA 05/08-09/09
. Conduct and document a thorough assessment of
each resident's medical
status.
. Provide supervision and counseling to unit
nursing staff.
. Act as a resource person for nursing personnel
and other staff.
. Coordinate staffing schedules to ensure
adequate coverage
. Ensure compliance with resident rights
policies while working with families and other
staff to resolve grievances.
Pre-authorization Coordinator, Southern Health
Services, Richmond VA
Assured members were utilizing contracted
providers and requested services were covered
benefits, medically necessary, appropriate and
of the highest quality.
Utilized established criteria to authorize
hospital admissions, diagnostic testing and
ambulatory services.
Served as a resource to non-clinical staff
ensuring information provided to members and
providers was current and accurate.
References Available Upon Request
Contact this candidate