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Utilization Review Prior Authorization

Location:
Dallas, TX
Posted:
December 06, 2022

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Resume:

Usoka Dabrinze

Aubrey, TX *****• adtwmp@r.postjobfree.com

Professional Summary

Professional proudly offering more than 10 years of expertise in nursing field. Well-rounded and personable individual experience in healthcare environments. Maintains positive relationships with case managers and providers. Remains polished and calm under extreme stress. Skills

Benefits Guidelines

Medication Side Effect Knowledge

Invoice Statements

Office Support

Patient Care Assessment

Clear Patient Communication

Accurate Documentation

Nursing Consultation

Obtaining Authorizations

Equipment and Instrument Sterilization

Medical Procedure Preparation

Continuous Assessments

Patient Examination

Compassionate and Caring

Work History

LPN Caseworker (Remote), 01/2019 to Current

Nurses Healthcare – Dallas, TX

Evaluated medical guidelines and benefit coverage to determine appropriateness of services. Performed admission reviews based for medical necessity based upon different system specification.

Obtained authorizations from multiple insurance carriers for various levels of care. Supervised and maintained all utilization review documentation . Performed prior authorization review of services requiring notification. Submitted cases for criteria failures and helped facilitate resolutions and approvals. Educated family members and caregivers on patient care instructions. Evaluated patient histories, complaints and current symptoms. Advocated for and strive to protect health, safety and rights of patient. Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.

Supervised and maintained all utilization review documentation Documented accurate and complete patient information to address patient problems and expected outcomes.

Performed routine evaluations of each patient's status, needs and preferences. Obtained patient vital signs and input/output measurements from inpatients. LPN Charge Nurse, 08/2011 to Current

Texas Health And Human Services – Denton, TX

Delivered direct quality care to patients by evaluating medical conditions and managing and assessing treatments.

Analyzed patient assessments and laboratory data to bring any issues to attention of physicians.

Assembled and used equipment such as catheters, tracheotomy tubes or oxygen suppliers to effectively manage patient care.

Managed daily staff assignments and patient scheduling to guarantee clinic coverage and flow. Promoted patient independence by teaching self-care skills and explaining conditions and medications.

Updated patient medical records with services provided, health conditions and response to treatments using .

Updated patient medical records with services provided, health conditions and response to treatments.

Updated patient medical records with services provided, health conditions and response to treatments .

Documented vitals and medical histories in patient charts when assessing patients and communicated patient information to physicians and other nurses for care continuity Education

Associate of Science: Nursing, 10/2010

Angeles Institute - Artesia, CA

Certifications

LPN License -

BLS



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