Remote Utilization Review RN

Heather Shows

Objective

To advance my career as a Registered Nurse while being employed remotely as a Utilization Review Specialist.

Education

ASSOCIATES PEARL RIVER COMMUNITY COLLEGE (MAY 2014)

Associate of Science in Nursing

UNIVERSITY OF TEXAS (2016)

12 credits completed towards Bachelor’s

ACM COMPASS MODULES (2018 – PRESENT)

Medicare and Medicaid, Utilization Management, Patient Classifications, Care Coordination

Skills & Abilities

COMPUTER SKILLS

Microsoft Word, Excel Spreadsheet, Outlook, PowerPoint, Zoom

ELECTRONIC MEDICAL RECORDS TRAINING

Midas, Interqual, Quadramed, McKessin, Care4, EPICS

Experience

UTILIZATION REVIEW SPECIALIST MEMORIAL HERMANN JANUARY 2018 - PRESENT

Reviews medical records, documents pertinent information and uses criteria subsets to determine clinical appropriateness for admission, continued stays and level of care. Collaborates with physicians and case managers to ensure progression of patients continuum of care while receiving the most appropriate services for their diagnosis. Collaborates with the physician and all member of the multidisciplinary team to facilitate utilization management; monitors patient’s progress and intervenes as necessary to ensure that the documented plan of care and services provided are patient-focused, high quality and cost effective. Actively participates in performance improvement activities as needed. Pursues individual professional growth by meeting requirements for mandatory continuing education and skills competency; supports department based goals; serves as preceptor/mentor to less experienced staff.

STAFF RN MEMORIAL HERMANN AUGUST 2015 – JANUARY 2018

Functioned as RN III caring for patients of primarily neurological and cardiac alterations. Frequently experienced with medical-surgical patients including renal failure, hepatic encephalopathy, psychiatric disturbances, and gastrointestinal diagnoses as well. NIHSS and ACLS certified. Performed daily staff RN role, in addition to experience with case management functions(PCS forms, MOT forms, etc.), charge nurse role(audits, patient call-backs, rapid response lead, etc), and nurse leadership roles (shared governance, clinical coach.) Frequently used skill include blood administration, central line maintenance, indwelling catheter insertion and maintenance, nasoduodenal feeding tubes, and telemetry monitoring and interpretation.

STAFF RN OCHSNER MEDICAL CENTER AUGUST 2014 – AUGUST 2015

Functioned in the role of a RN providing comprehensive care to adult patients experiencing acute medical-surgical health alterations. Most commonly care for patients with respiratory, cardiac, gastrointestinal, autoimmune/infectious disease, psychiatric alterations, and transplants. Frequently used skills include blood administration, PCA set-up/monitoring, gastrostomy & parenteral nutrition, telemetry monitoring, neurological assessment, and lab collection. Skilled in delegation and supervision of LPNs.

Accomplishments

DAISY Award for Extraordinary Nurses, February 2017

Clinical Excellence in Healthcare Award, October 2016

Chair of Unit Based Governance, June 2017

Cochair of Hospital-Wide Shared Leadership Council (Nurse Staffing Committee, Policies and Procedures Committee, Professional Practice Council), June 2017

Member of Quality and Safety Committee, June 2017

Member of MAGNET Certification Committee, January 2017

Member of Orientation of New Hires Committee, January 2019

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