Utilization Review Clinical Coordinator
Resume:
Ann Butler-Dawkins [Gregory], RN
***** ********* ***** ******, ********, FL 34711; Ph: 860-***-****(mobile)
e-mail: ********@******.***
Objective: To contribute an array of nursing skills and expertise serving as patient advocate in any given setting of patient management such as, insurance liaison, appeals and grievance clinical coordinator for concurrent/in-patient or pre and post procedures services, or any other appropriate nursing position.
Experience:
June 29, 2015 – Sept 22, 2022 (Temporary since January 18, 2015): Centene Corporation/AcariaHealth Specialty Pharmacy
oRegistered Nurse, Case Management in the setting of Specialty Pharmacy
Provided medication management in the form of counseling/education and adherence monitoring.
Logging all reported adverse events/side effects and medication adherence deficiencies.
Compliance with manufacturers and pharmacy contracts and programs
Provided appeals support by writing appeal letters for denied prior-authorization medication claims.
August 02, 2004 – June 02, 2014: Aetna Life and Insurance/Aetna Health Inc. (Aetna), CT, FL.
oRegistered Nurse, Complaint and Appeal Nurse Analyst; Clinical Claims Review, Medical Policy and Procedure Administration in the office and telework setting:
Clinical and claim reviews including utilization review panel hearing appeals; review and summarizes appeals and grievances related to members, providers, and practitioners: concurrent, pre and post medical, surgical, pharmacy, imaging, physical and rehabilitative, skilled nursing, and durable medical equipment services.
Coordinate and collaborate with health plan members, providers, plan sponsors, internal and external customers, and medical directors on various operation matters using a variety of software including Microsoft office as well as various applications.
July 1997 - August 2004: Catholic Health East/ Sisters of Mercy/Mercy Knoll, SNF/LTCF, CT
oCharge Nurse
Oversee unit in the daily care of residents and clients in a skilled nursing setting.
Initiate and coordinate plan of care for long-term residents and short term clients.
July 1995 - January 1997: Option Care, Clarkston, GA; Home Infusion Therapy
oIntake and Clinical Coordinator-Home IV Therapy (CRNI certification)
Provided home infusion therapy in the home setting, maintaining documentation and plan of care and coordinating staffing with clinical and pharmacy teams.
August 1986 - January 1995: Hartford Hospital, CT
oMedical Surgical (1986 – 1987): Cardiac, Liver and Kidney Transplant specialty nursing
oIntravenous Therapy (1987-1995) – Certification: CRNI
Administration of a wide variety of intravenous agents including medications, oncology chemotherapy, blood, and blood products.
Initiating and/or maintaining the integrity of peripheral and central lines as well as PIC placement and maintenance.
May 1983 - November 1985: University Hospital of the West Indies, Mona, Kingston, Jamaica:
oMedical Surgical Nursing.
Total patient care in the acute setting pre and post operatively for general surgeries.
Education: University of the West Indies School of Nursing—Graduated May, 1983.
References: available upon request.
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