Review Nurse Medical Records

Elizabeth Windom

Jackson, MS

Experienced job title licensed with strong clinical and people skills. Professionally trained job title with experience ensuring high standards of culturally competent care for a wide variety of patients with diverse needs. Responsible job title with excellent communication skills demonstrated by years of experience in healthcare. More than thirty years of various nursing experience. Work Experience

Nurse Reviewer Contract

Computer Merchants - Jackson, MS

October 2023 to March 2024

• Evaluated the appropriateness and medical necessity of requested services, treatments based on evidence based medicine.

Concurrent Review Nurse

Total Med Services - Jackson, MS

September 2021 to March 2023

contract Jackson, Ms.

As a concurrent review nurse, utilized the Interqual system criteria to determine medical necessity for inpatient stay of patients, managed concurrent reviews for patient’s continued hospital stay. Collaborated with the medical advisor on denials and approvals for patient’s hospital stay. Communicated with providers on authorization requests and reviews for patient’s hospital stay. Scheduled peer to peer conferences with medical advisors.

• Conducted comprehensive reviews of medical records to determine the appropriateness and necessity of healthcare services

• Utilized evidence-based criteria and clinical expertise to make informed decisions regarding medical necessity and level of care

• Achieved an average turnaround time of less than 24 hours for completion of utilization reviews

• Developed and implemented evidence-based guidelines for specific medical conditions, resulting in improved consistency and quality of care

RN Care Manager

Noble Healthcare - Monticello, MS

August 2019 to August 2020

Business closed due to COVID-19. Responsible for assessment of clients post discharge from hospital. Responsible for caseload of clients, assessing their needs and using various resources to meet their needs. Reporting to the PCP any changes of patient.

• Developed and implemented nursing care plans for patients, coordinating with interdisciplinary teams to provide comprehensive healthcare services

• Monitored patient outcomes and made necessary adjustments to treatment plans, resulting in improved patient satisfaction.

• Maintained accurate documentation of patient assessments, interventions, outcomes, and progress notes according to regulatory requirements

Utilization Review Nurse

University of Mississippi Medical Center - Jackson, MS November 2015 to April 2019

Responsible for sending patient clinical information to insurance companies to validate inpatient stay. Managed prior authorization for admission of patients’ usage of Interqual for patient level of care and to validate inpatient hospital stay. Also send concurrent clinical information for continued stay.

• Collaborated with healthcare providers to ensure compliance with established clinical guidelines and protocols

• Maintained a high level of accuracy in reviewing medical records, ensuring appropriate reimbursement for services provided

• Served as a liaison between insurance companies, healthcare providers, and patients to resolve issues related to coverage or payment disputes

Staff R.N.

Methodist Rehabilitation Center - Jackson, MS

July 1999 to November 2014

Managed care of post stroke and spinal cord injured patients.

• Provided direct patient care and nursing services in accordance with established policies, procedures, and protocols

• Administered medications, treatments, and therapies as prescribed by physicians or healthcare providers

• Assessed patients' conditions and implemented appropriate nursing interventions to ensure optimal outcomes

• Monitored vital signs, documented patient information accurately, and reported any changes or abnormalities to the healthcare team

• Educated patients and their families on disease management, treatment options, medication administration, and self-care techniques

• Responded promptly to emergencies by initiating appropriate interventions following established protocols

• Provided direct patient care and nursing services in accordance with established policies, procedures, and protocols

• Assessed patients' conditions and implemented appropriate nursing interventions to ensure optimal outcomes

• Administered medications, treatments, and therapies as prescribed by physicians or healthcare providers

• Monitored vital signs, documented patient information accurately, and reported any changes or abnormalities to the healthcare team

• Collaborated with interdisciplinary teams to develop and implement individualized care plans for patients

• Educated patients and their families on disease management, treatment options, medication administration, and self-care techniques

• Performed various diagnostic tests such as blood draws, EKGs, wound cultures under the supervision of physicians or advanced practice nurses

• Collaborated with other healthcare professionals to coordinate discharge planning activities for patients transitioning from hospital to home or other facilities

• Assisted in training new staff members on unit-specific policies/procedures Education

BSN in Nursing

Mississippi College - Clinton, MS

May 1997 to August 1998

ADN in Nursing

Hinds Junior College - Raymond, MS

August 1980 to May 1982

Belhaven University - Jackson, MS

August 1975 to August 1978

Lanier High School - Jackson, MS

May 1975

Nursing Licenses

RN

Expires: December 2024

State: MS

Skills

• Preceptor Thorough physical assessments

• Venipuncture/blood draw expert, a good resource nurse, well rounded in nursing and knowledgeable in nursing.

• Nurse Educator

• Computer skills

• Critical Care Experience

• Documentation Review

• Managed Care

• EMR Systems

Certifications and Licenses

RN License

BLS Certification

Compact State Nurse License

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