ROBIN REYNOLDS, RN, BSN

King William, VA ***** 804-***-**** ad0by0@r.postjobfree.com

PROFESSIONAL SUMMARY

Dependable RN seeking opportunity to utilize and expand skills and contribute to company success. Considered hardworking, organized, ethical and detail-oriented. Skilled at prioritizing daily assignments and contributing to team success. Excellent verbal and written communicator with strong background cultivating positive relationships and adapting to new needs and policies.

SKILLS

• Licensed RN • Utilization Review • Case Management

• Data Collection • EMR Systems Interpersonal And Written Communication

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• Accurate Documentation • Strong Clinical Judgment • Self-Motivated EXPERIENCE

RN Utilization Review Services May 2017 - August 2022 HCA Healthcare (Remote/Work from Home) Nashville, TN Evaluated initial inpatient admission and continued stay utilization review as needed for authorization procurement and mitigation of concurrent denials

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Conducted clinical review of the medical record, utilizing critical thinking skills for validation of admission status orders, completing medical necessity reviews through application of InterQual criteria, summarized relevant clinical information to present to payors

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Implemented strong written and verbal communication skills when interacting with payors, physicians and medical care providers regarding patient status, plan of care, clinical clarification, and concurrent denial mitigation strategies.

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• Adapted to staffing needs within our team assignments to identify and prioritize reviews for obtaining authorizations. Organized daily workflow to best utilize available clinical information and meet established timelines for clinical review completion and submission to payors.

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RN Utilization Review / Case Management March 2013 - April 2017 The Wellpoint Companies, Inc (Remote/Work from Home) Richmond, VA

• Conducted Utilization Review in Population Health Management/VA-Commercial Accounts Reviewed inpatient admissions using clinical information provided by physicians, providers, and electronic medical records to establish medical necessity based on criteria using MCG/Milliman protocol sets or clinical guidelines

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• Communicated with providers for clinical clarification, documentation and notification of decisions and authorizations

• Conducted Case Management as Case Manager II in Population Health Management/VA-Commercial Accounts Performed care management within the scope of licensure for WellPoint members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum and ensuring member access to services appropriate to their health needs.

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RN Clinical Nurse III July 2008 - August 2013

Children's Hospital of Richmond (CHoR) at VCU, Pediatric Richmond, VA Provided care in a 7-bed step-down unit of the academic teaching hospital/Level 1 Trauma Center whose patient population included infants, children, and adolescents

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Assessed patients with medical diagnoses encompassing all physiologic systems, most commonly those involving respiratory, neurological, or cardiac compromise

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• Provided care of surgical patients including cardiac, neurological, gastrointestinal, orthopedic, trauma, and ENT

• Participated in services and care to the patient with the concept of family centered care in mind

• Trained nurses as preceptor to new RN's and staff to the unit as well as nursing students assigned to the unit

• Served as charge nurse in this unit and appointed to various unit/department/hospital committees

• Provided cross coverage for General Pediatrics, PICU, NICU, Mother/Infant, and Burn Unit. Care Partner July 2007 - July 2008

VCU-Health System, Supplemental Staffing Richmond, VA Provided direct, age-specific care to a patient or group of patients based on medical orders and the plan of care under the direction of the RN

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Adapted to care for patient populations through Supplemental Staffing with assignments in any unit within the academic teaching hospital/Level 1 Trauma Center needing assistance; assignments were made in four-hour increments throughout the shift requiring flexibility and the ability to adjust and acclimate to varied clinical environments.

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EDUCATION

Bachelor of Science in Nursing - Nursing May 2013

Liberty University (Online), Lynchburg, VA

Associate of Science in Nursing - Nursing May 2008 J Sargeant Reynolds Community College, Richmond, VA AFFILIATIONS

CPN – Certified Pediatric Nurse

Previous member of Pediatric Professional Council at CHoR at VCU-HS Previous member of PICU/PPCU Evidence-Based Practice Committee at CHoR at VCU-HS Previous member of PICU/PPCU Preceptor/Clinical Ladder Committee at CHoR at VCU-HS

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