THERESA M. RICHARDSON, RN

**** ********** ***

Sacramento, CA. 95828

916-***-****

E-mail: ad2zma@r.postjobfree.com

OBJECTIVE: To secure a challenging career as a Health Care Professional utilizing technical and or analytical skills with either an insurance group, a consulting firm, or a health care organization that focuses on providing quality health care.

EXPERIENCE:

Innovage-Sacramento, CA

11/2022- present

RN Eligibility Enrollment

Performing assessments for the elderly population for The PACE program at Innovage. At PACE, the enrollee will receive all of their medical care, DME, medication, transportation to and from the center and to and from their specialist.

Magellen Rx- Sacramento, CA

12/2020 – 06/2021

Utilization and Prior Authorization Review Nurse-Remote

Providing Utilization Review and Prior Authorization for the MediCal population in California for prescription drugs. This was a remote position in which I am comfortable in a remote position. Used DHCS criteria for the authorizations.

All’s Well Health Care Services

01/2019- 03/2019- Case Manager

Worked a a temp performing Case Management at Brown & Toland and utilization review using InterQual criteria also have Experience with MCG.

CITY OF SAN MATEO (SAN MATEO MEDICAL CENTER)

09/2015 -03/2018-Clinical Nurse/Utilization Review

Performed utilization review using InterQual Criteria in an inpatient acute setting. Referred cases to the Medical Director when not meeting criteria or for questions regarding acuity.

HEALTH PLAN OF SAN MATEO SOUTH SAN FRANCISCO, CA

11/2014-09/2015 Utilization Review Nurse II

Performed utilization review for inpatient and home health reviews using Milliman Criteria Guidelines(MCG). Saved the company a significant amount of money resulting in over utilization of unnecessary medical services that were being provided through home health.

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KAISER PERMANENTE OAKLAND

03/2010-6/2015-Patient Care Coordinator/Case Manager

Role involved utilization review and discharge planning for Kaiser Permanente members and Non-Kaiser Permanente members in the Acute Care Setting. Used InterQual criteria.

CLINICAL EXPERIENCE:

Acute Care Staff Nurse. Registered Nurse worked as a staff nurse in acute care hospital settings, sub-acute care settings, and private duty. Level 3 NICU for 12 years, PICU, and Pediatrics. Have also done Flu Shot Clinics

EDUCATION:

1983 DES MOINES AREA COMMUNITY COLLEGE ANKENY, IA

Associate Degree in Applied Science

Registered Nurse

1977 DES MOINES AREA COMMUNITY COLLEGE ANKENY, IA

Practical Nursing Diploma

Licensed Practical Nurse

CREDENTIALS: Registered Nurse Licensed in California and Arizona, BLS

Experience using Epic, InterQual, MCG, Allscripts, MedHok

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