KAWANDA REID-Hamilton

*** *** ***** **. *******, MO 63368 C: 314-***-**** adwc7o@r.postjobfree.com

PROFESSIONAL SUMMARY

I have 8 plus years of managed care experience and business knowledge. My leadership skills are strong as I have

been in supervisory and management positions.

SKILLS

CareWeb QI, IDX, QNXT, Inter Qual (Care Enhanced by Provider Portal, Propat, Profax, Encoder Pro, Ionxy, RX

McKesson,) America, Cisco, Microsoft, UNK2, Amysis, Outlook, Teams, Excel, Word, VSeem Microsoft, WebX, Video Zoom, and, Covid Swabbing Machine, Teams, Duo, Infinity Infusion Pumps, Bivona Trachs, all ADL’s and personal care.

WORK HISTORY

Maxim Healthcare Staffing Agency 12/2022-Current

Private Duty Nurse

I go into patients home and provide total care, providing clinical documentation, g-tube care, trach care, perform all ADL’s, communicate effectively with the patients, families and physicians.

Actalent Agency 8/15/2022-1/2023

Utilization Review Nurse

Conducted daily review of authorization request for in home health RN/LPN/HHA and in home therapy services.

Perform telephonic 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 determination

Complete medical necessity and level of care reviews for requested services using clinical

judgment and refer to Medical Directors for review depending on case findings

Collaborate with various staff within provider networks and case management team

electronically or telephonically to coordinate member care

Educate providers on utilization and medical management processes

Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and

maintain pertinent clinical information in various medical management systems

Favorite Healthcare Staffing-St. Louis, MO 3/2021-1/2023

Covid vaccinator in Chicago, IL on a traveling assignment, assessed patients, gathered

Pertinent information, gave covid vaccination, currently working PRN as a covid swabber and

Covid vaccinator

Aetna Better Health of Missouri- St. Louis, MO/Arizona 07/2014 to 11/15/2021

Utilization Review Nurse

Coordination of decisions for all services requiring medical necessity reviews. Communicate with medical directors, management, physicians, office staff and members to assist with providing the best care for

members. Conducted daily review of authorization request for outpatient services, inpatient request, DME, medication management, and home health services. Additional duties include review the case management inbox, provider portal, review claim cases, assist with training new employees, and test/trial of new systems, department policies, and programs.

I was a part of a special team that worked on durable medical equipment, outpatient services, home health, sleep disorders, and enteral nutrition.

Independent Contractor with Missouri Mentor Network – St. Louis, MO 07/2012- to Current

In-home Foster Parent

I care for clients in my home with intellectual and/or physical disabilities, I provide 24 hour care, offer community

integration, and help my clients live as much as an independent life as possible.

Maximum Health Care – St. Louis, MO 08/2012 to 03/2013

Corporate Utilization Review Nurse for Centene Corporation

Reviewed prior authorization requests for multiple out of state health plans including Missouri, in order to coordinate and make decisions for all services requiring a medical necessity review. Conducted reviews on all services requiring an authorization such as inpatient request, outpatient services, DME, high dollar medication reviews and home health.

Molina Health Care of Missouri – St. Louis, MO 8/2008 to 3/2012

Utilization Review Nurse

Provided Coordination of decisions for all services requiring a medical necessity review including:

inpatient and outpatient hospital services, diagnostic imaging, out of network services, high cost medication and

injectable drugs, and the holistic care for all my members on the insurance side.

Interact with the medical director for Molina Health Care and communicate with providers in a professional manner

to ensure the delivery of high quality, cost effective healthcare.

Utilize clinical skills to support the coordination, documentation, and communication of medical services and/or

benefit administration determinations.

Responsible and proficient in communication, leadership, keyboard skills, and the ability to navigate through

multiple computer systems at once while operating on dual screens.

North Gate Park Nursing Center 09/2008 to 02/2009

Charge Nurse/Wound Care Nurse Supervisor

Responsible for the care of 40-50 patients through the direct supervision of 4-5 CNA's and 1 CMT, encompassing:

administering medications, vital signs, IV therapy administration, oxygen therapy, tracheotomy /colostomy care,

catheter insertion, caring for dialysis patients pre-post procedure, and g-tube care

Operates as the wound care nurse, changing dressings an applying wound vacs, taking preventive measures,

communicating with outside entities, complete weekly wound reports, continuously assess patients hydration status,

food consumption, medications, lab results, and healing process.

Cathedral Gardens Care Center – St. Louis, MO 4/2005-9/2008

Assistant Director of Nursing

Responsible for the direction of licensed and non-licensed personnel who provided health care and nursing services to

residents on a 24 hours 7 days per week basis.

Complementing the DON in planning, developing and supervising the activities of licensed and non-licensed staff, assist

with the development of implementation of nursing services, objectives, policies, and procedures in accordance with

Federal and State regulations.

Conducted walking rounds with physicians and the medical director, Conduct interviews for potential staff, orientation, in-services, pharmacy reviews, quality assurance meetings and reports, dietary consultations, oversee the wound program, complete weekly wound reports, close communication with the medical director and DON and administrator.

EDUCATION

High School Diploma: 1990

Arcadia Valley High School - Ironton, MO

Associate of Science: Nursing, perquisites for the RN program

Mineral Area Community College - Farmington, MO

Associate of Science: Nursing, 2004 IV Certified LPN

Applied Technology School of Nursing - St. Louis, MO

Associate of Science: Nursing, perquisites for the RN program

Florissant Valley Community College - St. Louis, MO

ORGANIZATIONS

Aetna Better Health Missouri AAERG 2015-present

Aetna Better Health Missouri Culture Club Committee 2015-present

Aetna Better Health Missouri Aetna Toastmasters VP, Membership 2016-present

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