Registered Nurse Medical

Linda R.K. Oughton, RN

*** **** ******, *.*. Box 100, Rochester, Texas 79544, *******@*******.***

Versatile individual with varied job experiences to provide excellent

opportunities to an organization looking for an employee who provides

dedication to the task with the planning, implementing and continuous

improvement for a company.

o Registered Nurse

o Utilization Review

o Case Management

o Manager

o Office Management

o Computer and web literate

o Team player

o Dedication

CAREER & ACHIEVEMENTS

TAIF MEDICAL CENTER, BAE SYSTEMS COMPOUND, Taif, KSA, Sept 2009 - May 2010

Practice Nurse - worked under indirect supervision of the lead practice

nurse and physician undertaking tasks and duties as required. Worked

collaboratively with the general practice team to meet the needs of the

patients, following policy and procedures.

Performed scheduled yearly physicals for employees and family members to

include EKGs, vital signs, pulmonary function tests, hearing screening,

blood draws and referrals as needed.

Assessed and treated patients on a walk-in basis for acute symptoms and

treated accordingly with indirect supervision of physician and lead nurse.

Charted appropriately and maintained records for patients and office.

Referred patients to physicians and hospitals in the local city as needed.

Performed inventory of medication and supplies ordering as needed.

Maintained safety checks on equipment per protocol.

SELECT ADMINISTRATIVE SERVICES - Gulfport, MS, April 2004 - Feb 2007

Case Manager/Utilization Review/Dept Manager- Evaluated the appropriateness

of pre-service procedures, hospital admissions and proposed lengths-of-stay

to help monitor and reduce unnecessary claims costs for third-party

insurance companies. Reported directly to the CEO.

. Used nationally accepted medical criteria and standards in the evaluation

process.

Worked closely with administrative and claims personnel to help assure the

timely and appropriate reporting.

Reviewed appeals received to include pre-service appeals and post service

appeals.

Maintained skills in clinical assessment/diagnosis/treatment sufficient to

develop and utilize access criteria to authorize services exercising sound

independent judgment and initiative within established policy guidelines

and maintaining confidentiality of information.

Supervised medical management staff regarding departmental issues and pre-

certification issues.

HUMANA MILITARY HEALTHCARE - Biloxi, MS, February 2003 - April 2004

Quality Care Coordinator - Investigated quality issues and worked with

medical affairs associates and provider partners to develop appropriate

plans to improve quality of health care delivery. Report to Department

Head.

. Entered all cases in the computer system when a potential quality issue

was identified. Closed cases at appropriate levels and entered notes

accordingly.

Reviewed Generic Occurrence Screen for potential quality issues on a weekly

basis and requested appropriate medical records.

Reviewed medical records and prepared cases for Area Field Office (AFO)

Medical Director's review and Regional Quality Management Committee (RQMC).

Assisted Area Medical Director in developing and implementing corrective

action plans based on patterns of care identified through QM reporting.

Assisted Area Medical Director in developing and implementing corrective

action plans based on patterns of care identified through QM reporting.

Prepared AFO quarterly reports for RQMC. Prepared standard report,

physician trends, and show trends of quality issues utilizing QI process

tools and techniques through data analysis. Prepared monthly important

aspects-of-care reports.

Reviewed quality of care issues and cases as required for focus reviews, re-

credentialing, clinical studies, grievances, and managed through the

approved QM process. Informed complaints were completed monthly.

ONE HEALTH PLAN - Dallas, TX, October 2001 - December 2002

Case Manager - Responsible for coordinating the medical care for members

whose condition warranted complex care management by high cost, complexity

or request.

Performed telephonic review and management of medical necessity, location

of care and length of stay in concert with providers and practitioners for

inpatient stay and discharge planning for catastrophic care.

Implemented a member centric care management process, apply a level of

interventions, and produce effective outcomes by reviewing referral for

appropriateness of care management interventions and performing effective

conflict resolutions.

Performed critical thinking with effective documentation. Functioned

independently and demonstrated an understanding of the medical management

functions, policies and procedures while acting as a resource for all

inquiries into the department and provided effective resolution to complex

issues with intuitive and investigational skills.

Coordinated the care of members in order to facilitate the development of

quality plans of care.

SUMMARY OF ANY PREVIOUS EMPLOYMENT 1984-2001

RICHARDSON MEDICAL CENTER, Richardson, TX, August 2001 - September 2001

OR Circulator - Circulated in operating room providing patient safety,

suite sterility, chart review, medication administration, and obtaining

required equipment for the surgical procedure.

TEXAS MEDICAL FOUNDATION, Austin, TX, October 2000 - June 2001

PEPP RN - Worked with hospitals under the Payment Error Prevention

Program (PEPP) monitoring improvement plans and quarterly reports to

insure compliance at decreasing the payment errors associated with the

Medicare Trust Fund.

HEALTH & HUMAN SERVICES COMMISSION, Austin, TX, February 1999 - October

2000

Utilization Review Nurse - Conducted utilization reviews for the Office

of Investigation and Enforcement Division of HHSC. Involved planning and

conducting hospital and nursing facility medical investigations and

reviews to determine accuracy of data, investigated alleged violations of

laws, rules and regulations regarding fraud in Medicaid coding, and

accuracy of diagnosis and procedural coding in hospitals and facilities.

CENTRAL TEXAS MEDICAL CENTER, San Marcos, TX, November 1994-February 1999

Registered Nurse - Responsible for safe, timely delivery of patient

centered care implementing the nursing process acting within Standards of

Care. Able to perform nursing functions in the following care areas:

o Operating Room Circulator August 1997-February 1999

o Circulated in operating room providing patient safety, suite

sterility, required equipment, chart review, and medication

administration.

o Cardiac Cath Lab Circulator May 1997-August 1997 & PRN - Circulated

in suite assisting with PTCA with fluoroscopy. Maintained patient

safety, sterility, and support to team.

o Pre-admission testing, Pre-op, PACU, Post-op July 1995-May 1997 -

Assisted patients with pre-admission testing, prepared patients for

OR with majority of day spent in PACU. Assisted with post-op

teaching.

o Intensive Care Unit Nurse and Charge Nurse November 1994-July 1995

- Worked in 10-bed ICU with multiple drug administration, trach

care, and ventilator patients. Rotated as charge nurse with three

employees.

o Emergency Room and Floor Nurse Floated - Floated to other areas of

the hospital when needed including emergency room and med/surg

floor.

SETON MEDICAL CENTER, Austin, TX, September 1991-November 1994

Advanced during Nursing School to Registered Nurse integrating the

nursing process within hospital policies. Performed patient assessments,

monitored and informed physicians of patients' status. Administered

medications accordingly. Gained experience in the following areas:

o Mother/Baby Registered Nurse August 1994-November 1994 -

Worked in the Mother/Baby unit carrying 5-6 couples. Extensive

teaching skills and assessment skills needed.

o Internal Medicine Registered Nurse January 1994 - August 1994

Heavy patient loads with extensive oral and IV medication

administration. Performed patient teaching and discharge instructions.

o Mother/Baby Student Nurse Tech I, II &III December 1992-December 1993

Worked under primary registered nurse performing patient assessments,

teaching, and charting while attending nursing school.

o Nursery Unit Communications Coordinator January 1992-December 1992

Completed chart assembly ordered medication, lab work and answered

phones for the newborn infant unit.

o Patient Accounts File Clerk September 1991-January 1992

o Infection Control Nurse Floated

EDUCATION, QUALIFICATIONS & PROFESSIONAL MEMBERSHIPS

HIAA Medical Management Certification-MMA; 2005.

Associate Degree in Nursing: Austin Community College-Austin, TX; 1993

Executive Secretary Diploma: American Commercial College-Lubbock, TX;

1980

FURTHER PROFESSIONAL ACTIVITY

. IV Therapy Essentials for Safe Practice - April 2012 - CEU online

. Diabetes Essentials for Nurses - April 2011 - CEU Online

. West Nile Virus - Novice to Expert Nurse -May 2009 - CEU Online

. Basic Trauma Nursing - August 2008 - CEU Online

. Computer Skills; Interqual criteria; MNR criteria; OMS; CCMS

. Skilled in web navigation and use of information processing tools

PERSONAL

USA Nurses License from State of Texas: Registered Nurse 602057

Contact this candidate