Utilization Review Nurse
Resume:
Sherri Beduhn
**** *. ******* ***. #**, Chicago, IL 60657
******.******@*****.***
Professional Summary
Experienced Utilization Review Nurse with more than 15years of clinical nursing experience. Mastered skill level for prior authorization of acute inpatient and outpatient care. In-depth knowledge of disease process, medical terminology, and diagnostic data. Tenured knowledge of managed care guidelines and regulations. Lead support in patient advocacy and collegial team player with proven top-notch healthcare skills. Experienced health care RN trainer in case management, treatment planning and coordination of care.
Skills
•Leadership
•Patient assessments
•Care Coordination
•Clinical Collaboration
•Problem-solving
•Utilization Review: Commercial/Government
Experience
Remote Patient Monitoring(RPM) Lead RN Sept 2021 Oct 2022
Canary Telehealth
Chicago, IL
•Provided medical management via RPM model of care for high risk patients with chronic medical conditions: HTN, DM, COPD, CHF & BH.
•Care Coordination of services with ambulatory providers and review of care plan with primary care MD and speicalty providers.
• Provided patient education to patients and families for medication management and progression of disease process.
•Facilitated care team meetings for emergent alert notifications with inpatient treatment team and outpatient providers for coordination of care.
•Provided leadership, supervision, new hire training and coaching for nursing staff and care coordinators.
Utilization Review Nurse Feb 2006 Feb 2020
Chicago Lakeshore Hospital Chicago, IL
•Drove quality and cost-effective care.
•Modified patient treatment plans as indicated by patients' responses and conditions.
• Monitored patients for medication compliance, effectiveness, reactions or side effects.
•Educated patients, family members and caregivers on conditions and treatment protocols to aid in compliance and improve outcomes.
•Collaborated with inpatient treatment team and outpatient providers.
•Provided leadership, training, supervision to Nursing Supervisors, staff nursing team, counselors and social workers.
Utilization Review Nurse Jan 2005 Feb 2006
Health Systems of Illinois Lombard, IL
•Provided authorization for acute medical and inpatient psychiatric care for the state of IL. utilizing InterQual Guidelines for Medicaid.
•Completed chart audits to ensure quality of care and escalated areas of concern to the medical director.
•Provided training to co-workers regarding criteria for inpatient psychiatric admissions.
Education
Bachelor of Science: Nursing Aug 1989
Loyola University Chicago, IL
Contact this candidate