Review Nurse Prior Authorization
Resume:
Monica Brasfield
**** *** ***** ** ********, MS *9073 731-***-**** ************@*****.***
Objective
Registered nurse with experience in telemetry, cardiac stepdown, home health, pain clinic, rapid admit/observation, perioperative nursing, and utilization management.
Objective Statement – Join a medical team that offers me a constructive and challenging work environment to contribute to reaching optimal healthcare standards and performance to enhance my nursing skills.
Education
Jackson State Community College, May 2002- May 2005
2046 North Pkwy, Jackson, TN 38301 731-***-****
Associates Degree in Nursing
Licensure
Compact state RN license, active in MS
MS License # 908551
TN License # 150015, inactive
Certifications
BLS Certified
Skills & Abilities
Team player Tolerance Adaptability Kindness Compassion
Effective interpersonal and communication skills
Active organizational skills and good analytical skills
Can work under stressful conditions and during irregular hours.
Computer and Internet experience, MS Office knowledge (Word, Excel), experience using Vergence, Cerner, Homecare Homebase, InterQual, Trucare, Facets, and Perspective Content-7.
Experience
May 24, 2021- Current
Utilization Review Nurse, Change Healthcare, Remote position
3055 Lebanon Pike, Nashville, TN 37214 615-***-****
UTILIZATION MANAGEMENT
Performs initial, concurrent, and/or retrospective review of services that require prior authorization or medical appropriateness review using health plan benefits, clinical appropriateness criteria, or plan guidelines/protocols. Documents clinical appropriateness reviews and care management activities in managed care operating Systems.
Facilitates cost effective and quality patient care by effective communication with physicians, providers and members.
Ensures authorized services are performed in the most cost effective appropriate setting.
Coordinate discharge planning activities for inpatient level of care services and facilitate referral to care management programs.
May 14, 2018- March 12, 2021
Prior-Authorization Nurse, Centene (Magnolia Health Plan)
111E Capitol St, Jackson, MS 39201 866-***-****
Employment verification: The Work Number: 1-800-***-**** Employer Code:14500
UTILIZATION MANAGEMENT
Perform review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations.
Complete medical necessity and level of care reviews for requested services using clinical judgement.
Enter and maintain pertinent clinical information in various medical management systems.
February 5, 2018- May 2, 2018
RN-Staff Nurse, St. Dominic’s Hospital
969 Lakeland Dr, Jackson, MS 39216 601-***-****
RAPID ADMIT/OBSERVATION NURSING UNIT.
Provided nursing care and medical treatment to patients of the medical center within the scope of practice as defined by state law.
Evaluated patient needs, prioritized patient care flow, and provided health treatments.
Conducted nursing assessments based on the patient’s history and his/her physical status by identifying critical medical signs.
Monitored patients for worsening condition.
Monitored and administered ordered medications.
Documented nursing procedures and maintained medical records in computerized charting.
Experience, continued
September 18, 2017-February 16, 2018 (December 28, 2017 last active work day)
August 2013- August 2014
RN-Field Nurse-prn, Medical Center Home Health
4039 Highland St #2, Milan, TN 38358 731-***-****
CARING FOR PATIENTS IN THEIR HOME. PATIENT EDUCATION, MEDICATION MANAGEMENT, WOUND CARE, AND MANAGEMENT OF DISEASE PROCESS.
Facilitated medical care – Identified critical medical needs and emergency situations and provided healthcare treatment within legal scope of medical/nursing practices.
Performed professional and health screening [lab] tests – Conducted appropriate laboratory tests and procedures.
Documented nursing procedures, maintained medical records and patient status, maintained a clean, sanitized, and safe environment.
July 25, 2005-September 1, 2017
RN, West TN Healthcare (Jackson-Madison Co. General Hospital)
620 Skyline Dr, Jackson, TN 38301 731-***-****
DURING THE TIME THAT I HAVE BEEN EMPLOYED HERE, I HAVE WORKED IN A CARDIAC STEP-DOWN UNIT, PERI-OPERATIVE UNIT, AND A PAIN CLINIC.
Provided nursing care and medical treatment to patients of the medical center within the scope of practice as defined by state law.
Evaluated patient needs, prioritized patient care flow, and provided health treatments.
Conducted nursing assessments based on the patient’s history and his/her physical status by identifying critical medical signs.
Communicated frequently with patients and their families.
Assisted in the administration of pain blocks and nerve blocks.
Prepared patients for outpatient surgery.
Recovered patients after outpatient surgery and made appropriate accommodations for follow-up appointments, physical therapy, or home health.
Documented nursing procedures and maintained medical records in computerized charting.
References
Peggy Pope, Brandon, MS 601-***-****
Charlotte Finley, Saltillo, TN, 731-***-****
Lisa Kelley, Scotts Hill, TN 731-***-****
Mary Newbill, Humboldt, TN 731-***-****
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