LaQuinta L. Hampton FNP-BC

***** **** ***** **** *** 1712 Katy, TX 77494 504-***-**** adhlag@r.postjobfree.com

Objective

I am an experienced clinical professional with diverse experience in providing quality care to patients, members and their family members. I am also an effective team member who implements and develops ways to build a quality team and quality patient care, while providing cost effective initiatives for all parties involved. I have a wealth of knowledge and greater than 10+ years of experience as a registered nurse and over 10+ years of direct clinical experience. I also have access to reliable transportation that will allow me the ability to travel to designated areas to provide client and/or patient care. I am willing and capable of spending time with members in their home . I also have experience as a home health nurse and provided home care to patients in their home in conditions that included: the presence of pets, with patients who were tobaccos users and patient’s that lived in deplorable conditions. I am also physically capable of lifting any heavy equipment weighing 30 pounds or greater and can navigate safely up and down stairs and through various dwelling conditions without any difficulty. I am a hard worker who isn’t afraid to take on new challenges and would like an opportunity to advance my career with the United Health Group family.

MASTERS OF SCIENCE IN NURSING 2018 HERZING UNIVERSITY

Major: Concentration in Family Nurse Practitioner

BACHELOR OF SCIENCE 2011 UNIVERSITY OF PHOENIX

Major: Nursing (BSN)

ASSOCIATES DEGREE 2005 DELGADO CHARITY SCHOOL OF NURSING

Major: Registered Nurse Licensure

Licensure

Active, unencumbered Family Nurse Practitioner -Licensed through the Texas Board of Nurse Examiners and certification through the American Nurses Credentialing Center (ANCC)

Active prescriptive authority from the Texas Board of Nursing

Ability to apply for and obtain DEA licensure

Active, unencumbered RN Compact License with the Texas Board of Nursing Examiners

Certifications

CPR, ACLS, BLS, PALS

Professional Membership

American Nurses Association and Texas Nurses Association

Skills & Abilities

Highly motivated clinician with excellent administrative and organization skills. I also have progressive experience in providing quality care in the Medical Surgical (Med-Surg) sectors, including but not limited to both In- and -Outpatient Oncology, Rehab, Observation and Post Acute Care to patients of the gerontology, cardiology, internal medicine, and Endocrine population. I am computer literate and can effectively navigate the internet without difficulty.

I have an extensive background in the Managed Care Industry, that includes utilization reviews, appeals and grievance processing and Prior Authorizations, letter writing and assisted Medical Director with medical reviews and final decision making.

I autonomously conducted in-home assessments, obtaining patients’ medical history, reviewed body systems and medication review for medication reconciliation. As a home health nurse I was also responsible for checking vital signs, and conducting physical assessment for patients’ newly admitted for home health services. I also communicated assessment findings with the provider office, educated the patients as it related to their individual disease process and/or medications.

Claims processing systems (Emdeon, FACETS, etc.)

Federal & State Regulatory Compliance (URAC, JCAHO, NCQA, HIPAA, STAR, CMS, TDI, LDI, Medicaid and Medicare Guidelines)

Microsoft Office Suite, WordPerfect, Compass, Navigator MicroMedex, Pyxis, MCG, Interqual.

Adopted and developed cultivating team building programs to maintain the highest quality and performance improvements

Experience

SPECIALTY PRACTICA IN FAMILY PRACTICE MSN PROGRAM

Collaborated with FNP preceptor to identify, diagnose and treat both acute and chronic conditions such as diabetes, hyperlipidemia, pain management, hypertension, kidney disease and other chronic medical conditions. Also assisted the FNP preceptor with treating acute conditions such as minor injuries and other acute medical conditions such as infections or exacerbation's of chronic diseases. Also assisted with documenting a list of the patient’s current and past medical conditions by applying my knowledge and when applying judgement to the findings from my physical assessments.

Assisted the FNP preceptor with documentation in the EMR, ordering and interpreting diagnostic labs, EKG, and x-rays.

Assisted with educating the patients on various disease process, treatment, and expected outcomes.

Assisted with inpatient hospital visits and discharges and rounds at skilled nursing facilities.

UNITED HEALTHCARE REMOTE/HOME-BASED JANUARY 2019 – PRESENT

PRIOR AUTHORIZATION NURSE

Assisted with the orientation of Provider’s to the Plan’s authorization and review processes, while working closely with participating Physicians to secure the necessary utilization management information.

Assured the medical necessity and appropriateness of the delivery of health care resources provided to members as per their benefit package, through medical review of inpatient and outpatient service requests, utilizing clinical judgement and Medical Director Guidelines.

Utilized and established criteria to authorize hospital admissions, diagnostic testing and ambulatory services, etc.

Conducts clinical reviews as they relate to Medicare Advantage Plan members using Centers of Medicare and Medicaid (CMS) guidelines and applicable criteria.

Assisted the the Tricare Global Nurse Advise Line (NAL) by assessing active duty service members, veterans, and/or their family member’s current health status and providing recommendations at the appropriate level of care based on clinical judgment and protocols. Assessed the beneficiaries understanding of their condition and identified potential care and/or provider gaps. Assessed and triage immediate health concerns and provided education and coaching techniques, and motivational skills to empower the beneficiary to take action and participate in the shared decision making process.

PEOPLE’S HEALTH METAIRIE, LA JANUARY 2013 – JULY 2018

MEDICAL RECORDS RESEARCH NURSE

Performed utilization management and medical record reviews on all assigned requests for Inpatient level of care services, transition of care services, outpatient testing and procedures as well as any other required services (DME, Home Care, Rehab) that may require medical necessity reviews in accordance to Centers of Medicare and Medicaid (CMS) Guidelines.

Ensured all documentation summaries related to the requested service(s) were completed and consistent with the applicable MCG/InterQual/CMS criteria and ready for Medical Director’s decision as applicable with case review.

Researched the Provider Network and created individual Letter of Agreements (LOAs) for services that could not be rendered with an in-network provider and/or facility due to network gaps

COVENTRY HEALTH CARE OF LOUISIANA METAIRIE, LA MARCH 2011 – JANUARY 2013

APPEALS & PRIOR AUTHORIZATION NURSE

Prepared and processed Provider and Member administrative and/or medical necessity appeals internally and externally, which included coordinating member care, based on Medicare guidelines for Commercial and Medicare plans.

Assisted with the orientation of Provider’s to the Plan’s authorization and review processes, while working closely with participating Physicians to secure the necessary utilization management information.

Assured the medical necessity and appropriateness of the delivery of health care resources provided to members as per their benefit package, through medical review of inpatient and outpatient service requests, utilizing clinical judgement and Medical Director Guidelines.

Utilized and established criteria to authorize hospital admissions, diagnostic testing and ambulatory services, etc.

Provided oversight of non-clinical staff in the screening of both verbal and written service requests, while serving as a primary resource for clinical issues to ensure information provided to member and providers were current and accurate.

Assisted in and prepared for accreditation reviews and audits for URAC and NCQA audits.

WESTBANK SURGERY CENTER HARVEY, LA NOVEMBER 2009 – MARCH 2011

PACU NURSE SUPERVISOR

Supervised admit and PACU staff as the daily charge nurse.

Managed infection control and chart audits on a monthly basis.

Admitted and recovered surgical patients (Pain Management, Orthopedic, Podiatry, ENT, GI and other general surgeries.

Obtained Pre-Operative medical and surgical history and post-operative evaluations on center patients.

Reviewed patient labs, EKG’s, and X-Ray’s in accordance to anesthesia requirements.

EAST JEFFERSON GENERAL HOSPITAL METAIRIE, LA 2001-05; 2006-09 & 2015 – 2017

STAFF/FLOAT POOL NURSE

Provided direct patient care to patients of the gerontology, cardiology, Endocrine, and internal medicine population. Administered treatment applications, which, may include taking vital signs, collecting fluid samples, drawing routine lab tests, dressing wounds, etc., in an appropriate and timely manner.

Delegated, monitored and followed-up on LPN and Certified Nursing Assistant (CNA) duties

Assembled and used catheters, tracheotomy tubes, oxygen supplies and feeding tubes for patient care.

Maintained client records, including patient care plans, problem lists, flow sheets, log books, communication board(s), maintained and followed progress notes within the patient’s medical charts.

Floated to different units within the hospital such as Med-Surg, Orthopedics, Oncology, Rehab, Observation, and Skilled Nursing units.

Safely and effectively lifted patients and equipment greater than 30 pounds and navigated along stairs and other various dwelling conditions within the hospital setting.

Educated patients and their families on the proper post-care and treatment procedures as per the discharge instructions

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