Patient Care Utilization Review
Resume:
IH Ivory Harris
Baltimore, MD ***** 443-***-**** ********@*****.***
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SUMMARY Patient-oriented Nurse with 30 years of diverse experience in direct patient care, staff supervision and department operations. Skilled at multitasking and prioritizing patient needs and daily assignments. Offering expertise with Hospice and Utilization review specialty. SKILLS Medication administration
Palliative care
IV and venipuncture
Interpersonal and written
communication
Patient needs assessment
Staff Development and Precepting
Body mechanics knowledge
Ventilator care
Medication and IV administration
Colostomy care familiarity
Diagnostic tools experience
Intake and discharge
Geriatric treatment knowledge
IV drug therapy management
Diabetes management
Unit administration
Acute and rehabilitative care
EXPERIENCE INPATIENT HOSPICE NURSE 02/2023 to CURRENT AccentCare Hospice Baltimore, United States
Guided patients' loved ones and caregivers in pain management, wound care and medication dosing.
Listened to patients and loved ones, offering emotional support and kindness to help with end-of-life transition.
Created and applied tailored care plans that would meet each patient's individualized needs.
Delivered respectful, compassionate care to each patient and family member. Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
Coordinated with healthcare team to establish, enact and evaluate patient care plans. Administered oral, IV and intra-muscular medications and monitored patient reactions. AGENCY REGISTERED NURSE 10/2022 to 02/2023
Medix Staffing Baltimore, United States
Collaborated with interdisciplinary teams for effective patient management, ensuring optimal treatment outcomes.
Performed concurrent reviews using MCG criteria.
Ensured patients admission are in compliance with Medicare by using MCG criteria. Reviewed electronic charts to provide documentation for admission/stay criteria. Analyzed appropriate data to identify trends/problems relating to delays in the delivery of care and patient placement.
PATIENT CARE COORDINATOR 10/2020 to 10/2022
Promedica Hospice Baltimore Maryland, United States Planned, coordinated and delivered care to patients and families as needed. Participated in Administrative On Call and On Call coverage. Delegated and assigned the patient/family to appropriate staff and team members. Maintained and facilitated interdisciplinary team/group meetings (IDG's) for continual updating of patient care plans.
Monitored compliance with rules and regulations of Federal and State regulatory agencies.
Reviewed case managers documentation for accuracy and compliance with all regulatory agencies.
Managed and coordinated work flows within Home Care Home Base (HCHB) UTILIZATION REVIEW NURSE 05/2016 to 04/2022
University Of Maryland Medical Center Baltimore
Determined medical necessity as directed by MCG or InterQual criteria for cost-effectiveness of services through utilization review processes. Detailed documentation on all utilization reviews by using Epic. Referred cases that do not meet MCG criteria to medical director for secondary review. Provided utilization review for inpatient level of care, observation and denials management for assigned patient case load. Interfacing with case managers, medical teams, physician advisors and payers.
TELEPHONIC UTILIZATION REVIEW NURSE 08/2013 to 05/2016 United Heathcare Baltimore, United States
Actively Monitored the care given in an acute rehab facility and approving bed days for continued stay authorization.
provided referrals for Transitional case management nurses or Disease Management nurses that serves as a connection to proper outpatient and/or home based services. Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations and procedural costs. REGISTERED NURSE, FLEX III 09/2011 to 04/2015
Bon Secour Hospital Baltimore, United States
Provided direct patient care/physical assessment on Med/Surgical Unit. Developed / Managed care plans, discharge planning instructions and health education to maximize and meet patients health and safety goals. RN CASE MANAGER 07/2012 to 08/2013
CareFirst Baltimore, MD
Engaged members in case management, through coordination of care with healthcare team and discharge planning.
Served as a key liaison between patients, families, and healthcare providers, fostering open communication and trust among all parties involved in the care process. Located / provided for appropriate home care/DME needs. Reviewed services and plans of care, also assessed members needs for health / medication management/ teaching needs.
RN, DIRECTOR OF CARE DELIVERY 10/2011 to 04/2012
HCR Manor Care Inc Baltimore
Oversaw Management of over 30 patients and staff for the Subacute Unit. Coordination and provision of direct patient care utilizing the nursing process. The clinical manager operationalized the objectives, policies, and procedures of the Medical Center and Clinical Services for a specific shift. Accountable for monitoring all department activity, including, but not limited to patient flow, appropriate staffing, assignments of care, and staff development. EDUCATION
AND
Associate of Arts General Studies
TRAINING Baltimore City Community College, Baltimore, MD MBA Business 06/2016
Strayer University, Washington DC
Bachelor of Science Nursing 06/2004
University of Maryland School of Nursing, Baltimore, MD
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