Sandra M. Cleaver, RN, nlc

260-***-**** adig94@r.postjobfree.com Indianapolis, IN 46236

Utilization Management RN

Dedicated, energetic, and reliable registered nurse (RN) with exceptional organizational and computer skills, excellent independent time management, and strong problem solving and decision-making abilities. Active team member providing professional judgment and skills ensuring applications, upgrades, and enhancements are successful with recognition to maintaining and coordinating system changes, performance testing, and system audits by applying medical benefit policy and medical management guidelines. Adept communicator emphasizing patience, compliance, and continuity of care.

Skills & Attributes

Proficient with Organizational Management, Identifying Issues, and Creating Resolutions

Facilitate Clinical Care Reviews, Utilization Management, Prior Authorization and Concurrent Review

Program Development Trainer and Patient Education Collaborative

Clinical Experience in Cardiovascular/Thoracic, OB/GYN, Family Practice, and Geriatrics

Precertification, Disability Determinations, Coding, and Billing Experience

Experience with Medic, Athena, and Multiple Hospital Programs

Computer Skills: MS Office, JIVA, InterQual, Client Letter, Right Fax, Zeomega, MMIS system

Work Experience

MDwise, Inc.; Indianapolis, Indiana 7/2015 – Present

Clinical Care Reviewer Utilization Management/Prior Authorization/Concurrent Review. Utilizes clinical nursing skills supporting the coordination, documentation, and independent determination of medical services. Well versed in Microsoft Word, Excel, Outlook, as well as InterQual, JIVA, Client Letter, Zeomega and MMIS system usage.

Recognized as “Star of the Month,” July 2016, for demonstrating proficiency during company merger. Nominated November 2016 and October 2017.

Annually passed audit, time compliance and usage review, as a requirement of the position.

Assisted with coordination and participated in Breast Cancer Walk and Heart Health Walk.

AmeriHealth Caritas (formerly MDwise Hoosier Alliance); Indianapolis, Indiana 9/2012 – 7/2015

Clinical Care Reviewer Utilization Management/Prior Authorization/Concurrent Review.

Well versed in InterQual, JIVA, Client Letter, Facets, and MMIS system usage.

Daily use of Microsoft Word, Excel, and Outlook.

Implementation and utilization of chart templates for audit proficiency.

Trained new employees to spreadsheet usage and template usage.

95-100% on quarterly audits.

100% on JIVA quarterly IRR usage review.

Lutheran Medical Group (formerly Indiana-Ohio Heart); Fort Wayne, Indiana 4/1998 – 9/2012

Office RN for seven physician cardio-vascular & thoracic practice. Previous positions included Surgical Scheduling Coordinator and Office Surgical Coder/Biller.

Coordination of exams, procedures & treatments, education, documentation, compliance, and phone triage.

Development and implementation of education & treatment plans for pre and post-surgical patients.

Effectively implemented physician orders, diagnostic tests, procedures, consultations, and precertification.

Computer knowledge of Web-chart, Athena, Microsoft Word, Excel, Outlook, and internet researching.

Created CPT & ICD-9 encounter form, surgical and scheduling forms, history and physical form, and hospital consult form.

Facilitated surgical scheduling organizational policies and procedures, office safety methods, precertification and documentation collaboration.

Instrumental in developing office procedures manual.

Annual updates and training for coding and billing.

Sandra M. Cleaver, RN

Page Two

Professional Experience Continued

GYN/OB Consultants; Fort Wayne, Indiana 12/1990 – 4/1998

Office and Clinical RN for eight physician OB/GYN practice. Prior office surgical procedure RN, RN Patient Educator, coordinated patient research studies, and developed RN surgical scheduling/precertification position.

Coordination exams, procedures and treatments, education, care documentation, and coordination of diagnostic tests.

Successfully participated in several office patient research studies.

Presented office in-service trainings for office surgical procedures.

Implemented patient education plan for prenatal and surgical patients.

Developed surgical scheduling, insurance precertification and procedure precertification guidelines.

Facilitated group breast cancer walk and fund-raising luncheon.

Physicians Plaza; Fort Wayne, Indiana 6/1984 – 12/1990

Office RN for family practitioner in 12 physician practice. Exclusive office nurse treating 50-60 patients, daily.

Built positive family relationships with medical care from birth to elders.

Implemented nursing care of immunizations, medication and allergy injections, office treatments and surgeries, fracture care and casting, assisted with school and sports physicals, and phone triage.

Participated on interdisciplinary committee for betterment of practices.

Coordinated monthly conference speakers for physician grand rounds education program.

Provided quarterly school hands-on education program.

Facilitated hospital and nursing home admissions.

Education

Nurse Licensure Compact (RN NLC); Indianapolis, Indiana

Associate Degree in Nursing (RN)

Indiana University/Purdue University; Fort Wayne, Indiana

Licensed Practical Nurse Degree

Ivy Tech Community College; Bloomington, Indiana

Nursing Major

Ball State University; Muncie, Indiana

Professional Development

Annual Diversity and Inclusion Updates: 2020 Unconscious Bias and You

Quarterly Local Nursing Update CME Seminars

Annual Diversity Update Training

Annual Adult, Child, Infant CPR & First Aid Course Completion

Annual Fire Safety Seminar & OSHA Compliance Training

Annual National Society of Thoracic Surgery Procedure, Coding, & Billing Seminars

Annual National Society of Vascular Surgery Procedure, Coding, & Billing Seminars

Prior Red Cross Water Safety & First Aid Instructor

Contact this candidate