Prior Authorization Vocational Nurse
Resume:
Jamie L. Webb
Conroe, TX 77385
EDUCATION: VOCATIONAL NURSING PROGRAM
NAPA VALLEY COLLEGE
NAPA, CALIFORNIA
MAY 2002
MEDICAL ASSISTING
SOLANO COUNTY REGIONAL OCCUPATION PROGRAM
FAIRFIELD, CALIFORNIA
JANUARY 1996
GENERAL EDUCATION
SOLANO COMMUNITY COLLEGE
SUISUN, CALIFORNIA
1992- 2001
GENERAL EDUCATION
SONOMA STATE UNIVERSITY
ROHNERT PARK, CALIFORNIA
1991- 1992
GRADUATE
VALLEJO HIGH SCHOOL
VALLEJO, CALIFORNIA
1991
WORK
EXPERIENCE: LICENSED VOCATIONAL NURSE
INTEGRANET HEALTH
PRIOR AUTHORIZATION NURSE
HOUSTON, TX
2022-present
*Review prior authorization requests for medical necessity.
*Maintain turnaround times for standard and urgent requests.
*Communication with Physician Offices.
*Communication with Medical Director.
LICENSED VOCATIONAL NURSE
NWDC IPA
PRIOR AUTHORIZATION NURSE
SPRING, TX
2021-2022
*Review prior authorization requests for medical necessity.
*Maintain turnaround times for standard and urgent requests.
*Communication with Physician Offices.
*Communication with Medical Director.
LICENSED VOCATIONAL NURSE
KELSEY-SEYBOLD CLINIC
CLINIC NURSING
THE WOODLANDS, TX
2021-2021
*Assist Physicians and patients.
*Take vital signs and record them, administer medications.
*Prescription refills, answer telephone calls, request referrals.
LICENSED VOCATIONAL NURSE
SPECTRUM REVIEW SERVICES
PRIOR AUTHORIZATION NURSE
SPRING, TX
2020-2021
*Reviewed prior authorization requests for medical necessity.
*Reviewed concurrent inpatient admissions for medical necessity.
*Maintained turn around times for standard and urgent requests.
*Communication with Physician Offices.
*Communication with Medical Director.
LICENSED VOCATIONAL NURSE
MEMORIAL HERMANN/NURSING SERVICES/BED CONTROL
CONROE, TX
2019-2020
*Participate in daily bed rounds with hospital staff.
*Assigning patient beds in bed management program.
LICENSED VOCATIONAL NURSE
DIGNITY HEALTH/ PRIOR AUTH NURSE
WOODLAND, CA
2016- 2019
*Assisted outpatient case management with all discharge needs.
*Reviewed prior authorization requests for medical necessity.
*Participated in daily conferences with UM Medical Director.
*Assisted UM Medical Director with the denial process.
*Assisted with the appeals process.
LICENSED VOCATIONAL NURSE
RIVER CITY MEDICAL GROUP / PRIOR AUTH NURSE
SACRAMENTO, CA
2015-2016
*Reviewed prior authorization requests for medical necessity.
*Participated in daily conferences with UM Medical Director.
*Assisted UM Medical Director with the denial process.
*Assisted with the appeals process.
LICENSED VOCATIONAL NURSE
CENTENE/PRIOR AUTH NURSE
SACRAMENTO, CA
2014-2015
*Reviewed prior authorization requests for medical necessity.
*Participated in daily conferences with UM Medical Director.
*Assisted UM Medical Director with the denial process.
LICENSED VOCATIONAL NURSE
DIGNITY HEALTH/ PRIOR AUTH NURSE
RANCHO CORDOVA, CA
2013-2015
*Reviewed prior authorization requests for medical necessity.
*Participated in daily conferences with UM Medical Director.
*Participated in health plan audits.
*Assisted UM Medical Director with the denial process.
*Assisted with the appeals process.
LICENSED VOCATIONAL NURSE
NORTHBAY MEDICAL CENTER/ UTILIZATION COORDINATOR
FAIRFIELD, CALIFORNIA
2012-2013
*Reviewed inpatient and observation admissions for medical necessity.
*Reviewed electronic medical records for appropriate documentation.
*Participated in daily conferences with Physicians and nursing staff.
*Responsible for daily communication to multiple health plans with appropriate clinical documentation to ensure financial payment.
LICENSED VOCATIONAL NURSE
PARTNERSHIP HEALTH PLAN/ ONSITE REVIEW NURSE
SUISUN, CALIFORNIA
2009-2012
*Assisted inpatient case management with all discharge needs.
*Onsite nurse reviewer.
*Reviewed electronic medical records for appropriate documentation.
*Participated in daily conferences with Physicians and nursing staff.
*Assisted with discharge needs.
LICENSED VOCATIONAL NURSE
VACAVALLEY HOSPITAL/ UTILIZATION NURSE
VACAVILLE, CALIFORNIA
2008-2009
*Reviewed inpatient and observation admissions for medical necessity.
*Reviewed electronic medical records for appropriate documentation.
*Participated in daily conferences with Physicians and nursing staff.
*Responsible for daily communication to multiple health plans with appropriate clinical documentation to ensure financial payment.
LICENSED VOCATIONAL NURSE
KAISER PERMANENTE/ URGENT CARE AND INJECTION CLINIC
VALLEJO, CALIFORNIA
2003- 2008
PHARMACY CLERK
MEDICAL ASSISTANT
KAISER PERMANENTE
VALLEJO, CALIFORNIA
1996- 2003
CERTIFICATES: CPR AND FIRST AID
LICENSE: VOCATIONAL NURSING
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