Dionne Williams BSN, RN

504-***-**** ad3p94@r.postjobfree.com LinkedIn URL https://www.linkedin.com/in/dionne-williams-Mar2005

EDUCATION and AFFILIATIONS

Bachelor of Science in Nursing - West Coast University, Dallas TX Graduated: 01/2023

Associate in Vocational Nursing - Concorde Career College, Arlington TX Graduated: 01/2005

LICENSE and CERTIFICATIONS

Registered Nurse Expires 03/2024

Basic Life Support (BLS) – American Heart Association Expires 09/2025

Advanced Life Support (ALS) - American Red Cross Expires 10/2025

Pediatric Advanced Life Support (PALS ) - American Red Cross Expires 10/2025

Trauma Nurse Core Course (TNCC) Expires 11/2025

Emergency Nursing Pediatric Course (ENPC) Expires 11/2025

PROFESSIONAL EXPERIENCE

HCA Healthcare: Medical City Arlington Emergency Department RN – Arlington, TX 07/2023 – Current

·Level II (Major) Trauma facility with patients requiring urgent treatment due to a life-threatening medical condition, illness or injury as well as patients with less serious conditions.

·Quickly access and prioritize incoming patients.

·Perform comprehensive nursing assessments and stabilize patients.

·Provide direct nursing care and supervise non-licensed nursing staff in accordance with established policies.

·Provide patient education/follow-up care instructions and make necessary referrals.

Molina Healthcare: Field Case Manager, LTSS – Dallas, TX 01/2023 – 10/2023

·Work with members and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum.

·Facilitate delivery of behavioral health and long-term care, for members with high need potential.

·Ensure patients progress toward desired outcomes with quality care that is appropriate and cost-effective.

Utilization Review Quality Specialist: Dane Street, LLC – TEMP Remote Contract 12/2022 – 04/2023

·Evaluate the quality of the physician's report to ensure it meets all client and jurisdictional standards.

·Ensures that the clinical rationale supports the physician’s determinations using ODG and MTUS guidelines.

·Read and apply policy guidelines, healthcare terminology and delineate when criteria is/is not met.

·Worked from home independently with limited supervision

·Provide clinical knowledge and act as a clinical resource to non-clinical staff

Medical Review Nurse: OneShare Health, LLC - Irving, TX 09/2020 – 09/2021

·Audited and analyzed medical records to determine if conditions were excluded or pre-existing.

·Generated pre-conditioned/denial letters for pre-existing or excluded conditions.

·Provide clinical knowledge and act as a clinical resource to non-clinical staff.

·Work with healthcare professionals to collect additional data and clarification as needed.

·Worked from home independently with limited supervision.

Onsite Health Monitor: Medix Healthcare - Dallas, TX 02/2020 - 05/2021

·Checked and reported abnormal temperatures of employees and visitors upon arrival during the COVID crisis.

·Utilization review contract with BCBS in 02/2020 reviewing commercial insurance requests for medical appropriateness utilizing the appropriate clinical decision support tools (i.e., Milliman, InterQual, and Orthonet).

·Work with healthcare professionals to collect additional data and clarification as needed.

·Worked from home independently with limited supervision.

Utilization Review Supervisor: Health Direct Inc./subsidiary of AIG 01/2017 - 12/2019

·Conducted ongoing availability and monitoring of staff as part of the intake and delegating process.

·Accomplished team goals by demonstrating leadership, including educating, delegating responsibilities and tracking monthly performance and metrics.

·Provided ongoing training on URAC standards and perform quality audits for licensed staff based on standards.

·Acted as a clinical resource for Claims Adjusters, Case Managers, Utilization Reviewers and non-clinical staff.

·Supervised non-licensed staff in high volume clinical call center.

Utilization Review Nurse: Health Direct Inc./subsidiary of AIG 02/2015 - 12/2016

·Reviewed worker’s compensation requests for medical appropriateness using nationally recognized evidenced based clinical criteria or approved medical guidelines (i.e., ODG and MTUS)

·Reviewed for surgical interventions, pharmacy, DME requests, and inpatient facilities SNFs, IRFs, and LTACs.

·Provide clinical knowledge and act as a clinical resource to non-clinical staff.

·Work with healthcare professionals to collect additional data and clarification as needed.

Utilization Management Nurse: Aetna Insurance - Dallas, TX 11/2010 - 01/2015

·Utilized MCG along with Medicaid and Medicare managed care guidelines to determine medical necessity.

·Reviewed initial and concurrent requests for inpatient SNFs, IRFs, and LTACs, Home Health, DME, and supplies.

·Assisted in discharge planning with Home Health Nursing requests and DME requests.

·Created and generated time sensitive adverse determination letters.

·Work with healthcare professionals to collect additional data and clarification as needed

·Worked from home independently with limited supervision

CORE QUALIFICATIONS, SKILLS & CERTIFICATIONS

·Extensive experience in utilization review, quality assurance and other cost management programs.

·Over 18 years of Word, Excel, Outlook, PowerPoint and Medical Databases.

·Well versed in appeals process with close attention to detail.

·Excellent problem-solving and decision-making skills.

·Over 8 years of clinical practice experience.

·Over 13 years of managed care experience combined.

REFERENCES

· References available upon request.

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