Utilization Review Customer Service

Nipa Patel, BSN RN

Phone: 601-***-****

**************@*****.***

LinkedIn: https:// www.linkedin.com/in/nipakpatel

Summary : I am a caring and detailed oriented Registered Nurse with an extensive clinical background and recently obtained utilization review experience with Remote Learning Services. My nursing background in Home Health and Medical-Surgical acute care has given me the foundation that is needed in Utilization Review by using my knowledge through experiences in acute and chronic environments. I can work well independently under general instruction and in a team environment. I have comprehensive knowledge of computer systems, experienced in a fast-paced work environment and electronic health records. My desire to use my solid knowledge base, critical thinking skills and evidence-based guidelines during the determination process.

Skills

●Utilization Review

●Home Health

●Medical/Surgical

●Care Coordination

●Admissions Reviews

●Appeals/Denials

●Discharge Planning

●Medicare/Medicaid

●Knowledge of Claims/Billing

Employment:

●Concurrent Reviews

●Retroactive Reviews

●Preauthorization

●Attention to Detail

●EMR/EHR/Oasis

●Excellent Time Management

●Mentor/Nurse Leadership

●Critical Thinking

●Attentive Customer Service

Medical/Surgical RN at Tristar Southern Hill Medical Center, July 2022- Present

●Educate patients and families on surgical procedure and post-surgery care.

●Educated clients, patients, and caregivers on medical diagnoses and treatment options.

●Responsible for admissions and discharge planning as ordered.

●Demonstrated high standards of performance including teamwork and compassion.

●Collaborated across disciplines to give every patient optional care and support.

Admission Nurse RN at NHC Home Health, July 2018-September 2022

●Responsible for attending case conferences, in-service, and supervision of HHAs and licensed practical nurses.

●Evaluate patients referred to home care services and determine the services provided.

●Admitting the patient to home health to provide medical care in their homes based on their needs, interviewing patients and families to obtain vital information during admission, ensuring appropriate evaluation to social service, physical therapy, occupational therapy, and home health aide services are made.

●Assess the home environment for safety, falls, proper medication storage, and community resources needs.

●Regularly evaluates HHAs and LPNs performance, provides feedback and disciplinary action when required.

Nursing Supervisor/RN at National Healthcare Corporation- NHC, September 2016 -May 2018

●Responsible for delegating and supervising CNAs and LPNs on their daily tasks on a 96-bed skilled nursing facility, including a long-term care floor for dementia and Alzheimer's patients.

●Full scope nursing with daily phone contact with physicians, patient’s families, home health partners, and therapeutic communication with the healthcare team.

●Communicates effectively with different vendors as needed for care and medical necessities.

Professional Education:

Utilization Review-101, Certificate of Completion - 2/2023

Remote Learning Services, LLC, taught by Marie Peppers LPN and Judy Clarke, RN

Walden University- MSN- Nursing Informatics, Minneapolis, Minnesota, USA, April 2021 - Jan 2023

University of Rajiv Gandhi University of Health Science, BSN-RN, Karnataka, India, August 2006-Sept 2010

Licenses: MN Board of Nursing, RN 214246 May 2016 - Current

Karnataka RN 06x8612 May 2011- May 2014

Gujarat RN A-II/H-II-2316 June 2012-October 2017

Certifications: Psychiatrist Nursing Training Certificate

Memberships:

American Nurses Association (ANA)

American Nursing Informatics Association (ANIA)

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