ANDREA AFOLABI – RN, MPH

Douglasville, GA *****

678-***-**** adt263@r.postjobfree.com

PROFESSIONAL SUMMARY

•Healthcare professional and educator with 27 years of practical nursing experience in the clinical settings, Inpatient and Outpatient.

•A comprehensive 12 years of Managed Care Operations Management background encompassing: Utilization Review, Case Management, Disease Management, Prior Authorization, Utilization Review, Intake, and Medical Necessity Denial and Reconsideration.

•Strong leadership abilities in leading peers, passionate team building, and employee engagement.

•Excellent communication skills, working with cross functional internal departments and external clients to meet needs by providing quality care and excellent services.

•Readily develop rapport with patients, families, and other health care professionals from a variety of cultural and socio-economic backgrounds.

•Strong analytical skills to easily assess conditions and implement appropriate intervention.

•Demonstrated aptitude for developing new skills and working as a team player.

•Shared Governance leadership lead.

•Computer Skills: Microsoft Office, PowerPoint, and Excel

•Clinical Documentation: Epic, Cerner, and InterQual

PROFESSIONAL EXPERIENCE

WellStar Atlanta Medical Atlanta, GA 12/2021 - Present

Staff Nurse (Telemetry & Stroke Unit)

•Implement total nursing care through a team nursing process

•Patient advocate by assessment, and notifying physicians of clinical changes

•Provide daily education to patients and family members

•Coordinate services, treatments, and consultations for patients

•Participate in daily rounds for discharge planning and Care coordination

•Educate patient and family members on treatment plan, medication, and discharge planning

•Administer pharmaceuticals, intravenous fluid, blood & blood products, enteral and parental nutrition under the scope of nursing

Travel Registered Nurse

Tanner Medical Center (ER & Medical Surgical Telemetry) Villa Rica, GA 02/2022 - 04/2022

Memorial Herman Northeast (Medical Surgical/Telemetry) Humble, TX 10/2021 – 12/2021

•Implemented total nursing care through a team nursing process

•Patient advocate by assessment, and notifying physicians of clinical changes

•Provided daily education to patients and family members

•Coordinated services, treatments, and consultations for patients

•Participated in daily rounds for discharge planning and Care coordination

•Educated patient and family members on treatment plan, medication, and discharge planning

•Administered pharmaceuticals, intravenous fluid, blood & blood products, enteral and parental nutrition under the scope of nursing

Centene Corporation (Peach State Health Plan) Atlanta, GA 05/2010 – 07/2021

Director of Nursing for Utilization, 07/2019-07/2021

•Direct oversight of Utilization Management (UM), Home Health/DME, and initiative for Medicaid, Medicare, and Marketplace

•Direct oversight of Intake/ Referral, Prior Authorization, Utilization Management, Home Health/DME, Medical necessity Denial and Reconsideration units

•Participated in new business implementations such as Medical Retrospective Review and Denial unit

•Provided input strategic decisions and budget for UM/CM programs along with reviewing, analyzing, and determining high-cost divers, operations, and health benefits ratio initiatives.

•Lead team to drive member’s health outcome, timely medical necessity reviews and maintain compliance with NCQA and CMS standards

•Participated in creating clinical policies and updates

•Participated in the Utilization Management Committee meeting

•Participated in Integrations and contract renewals

Nurse Manager, Prior Authorization and Utilization Management, 07/2014 – 07/2019

•Responsible for supervising and leading Inpatient surgical admission review, Prior Authorization and Home health and durable medical equipment (DME) teams

•Oversight of Utilization Management (UM), and initiative for Medicaid, Medicare, and Marketplace

•Prepared and reviewed daily authorization reports pending medical necessity reviews

•Implemented and provided oversight for home health and DME units for medical necessity reviews

•Implemented and supervised pilot program for home visit and DME delivery with members who were potential for readmission

•Developed, implemented, and maintained policies and procedures regarding the specified area function

•Conducted staff monthly audits, review staff annual performance reviews, and create standard operating procedures

•Reviewed elements of Interrater Reliability testing with staff annually doing study groups

•Identified quality, risk management issues, and facilitated the collection of information for quality improvement and reporting purposes

•Compiled and reviewed multiple reports for statistical, and financial tracking purposes to identify utilization trends and assist in financial forecasting.

•Maintained government compliance, contractual guidelines, and objectives of the health plan

•Maintained compliance with National Committee for Quality Assurance (NCQA) standards for case and utilization management functions

Prior Authorization/Concurrent Review/ RN Case Manager ll (Medicaid, Medicare & Marketplace), 05/2013 – 07/2014

Prior Authorization/Concurrent Review/Oncology RN Case Manager ll (Medicaid), 01/2012 – 05/2013

Prior Authorization/Concurrent Review RN Case Manager l (Medicaid), 05/2010 – 12/2012

•Reviewed prior authorization requests through fax or telephone to ensure medical necessity for service requested

•Reviewed request for extended Inpatient length of stay in hospitals, rehabilitation centers and Nursing homes

•Clinical resource to referral staff and a liaison between the provider and the medical director

•Maintained proper written documentation in patient charts to meet NCQA and PSHP standards

•Utilized nationally recognized criteria InterQual, clinical policies to determine medical necessity for service requiring preauthorization

•Assessed, enrolled, and educated members in Case Management

•Nurse clinical resource and a liaison between the provider and the member

•Educated and implemented the nursing process to meet member and family needs

•Maintained proper written documentation in patient record including STAR reports to meet NCQA and PSHP standard

•Developed plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes (improve HEDIS/QRS and STAR measures)

•Worked on special projects related to case management as needed

WellStar Douglas Hospital Douglasville, GA 05/2013 – 08/2014

Staff RN, Float Pool (ER, Med Surg, ICU)

•Implemented total nursing care through a team nursing process covering ER and seven high acuity patients per shift

•Patient advocate: assessed patient status and notified physicians of clinical changes

•Coordinated services, treatments, and consultations for patients

•Administered chemotherapeutics, pharmaceuticals, blood & blood products under the scope of nursing

•Provided education to patients and family members

Chattahoochee Technical College Hiram and Acworth, GA 07/2010 – 08/2014

Practical Nursing/Clinical Adjunct Instructor

•Supervised and evaluated students at the clinical sites

•Provided a model for students to follow

•Provided critical thinking, organization, planning, written and oral communication skills

•Performed clinical tasks according to hospital policy

•Provided hands-on training in clinical skills lab

Grady Health System Atlanta, GA 06/2005 – 03/2011

Senior Staff RN, Outpatient Infusion Center (alternating charge nurse), 10/2006 – 03/2011

•Treated and educated Oncology patients regarding chemotherapy, central line management, and blood products

•Assessed patient response and coping skills for dealing with side effects of chemotherapy and Oncology diagnosis

•Nurse clinical liaison between Clinician and patient; providing pain management, prescription requisitions, and needs assessments

•Maintained proper written documentation in patient charts to meet both hospital specific and JCHAO standards

Sr. Staff RN, Critical Care Central Line Mgmt. Team (alternating charge nurse), 06/2005 – 10/2006

•Provided maintenance of central line per shift

•Assisted and support Central Venous line insertion

•Provided in-services to nursing staff/quality improvement and patient safety

•Performed clinical tasks according to hospital policy

WellStar Cobb Hospital Austell, GA 10/2000 – 07/2006

Staff RN, Medical Oncology/ Surgical Unit (alternating charge nurse/float)

•Implemented total nursing care through a team nursing process covering seven high acuity patients per shift

•Patience advocate: assessed patient status and notified physicians of clinical changes

•Administered chemotherapeutics, pharmaceuticals, blood & blood products under the scope of nursing

•Provided education to patients and family members

EDUCATION

•South University - Savannah, GA

oMaster of Public Health

•University of Phoenix - Phoenix, AZ

oBSN, Bachelor of Science in Nursing

•North Shore Community College - Danvers, MA

oAND, Associates in Nursing

•Massachusetts Bay Community College - Framingham, MA

oLPN Licensed Practical Nurse

CERTIFICATIONS AND LICENSURES

•Certified by the American Heart Association for BLS for Providers

•Certified by the American Heart Association for ACLS

•Registered Nurse -Compact State, Massachusetts and Georgia licensed

•Certified Faith Community Nursing Network at Northside Hospital 2020

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