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Utilization Review Full Time

Location:
Camarillo, CA
Posted:
May 05, 2023

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Resume:

Kristen Pinkerton RN

805-***-****

adwxy9@r.postjobfree.com

****-**** ** ******** **********, Full Time

Kabafusion

Cerritos, California

Case management responsibilities for in home IVIG, chemo., IVAB, Biologicals, SCIG, hydration, via central, Ports, PIV and PICC access. Curlin pump. Multiple delivery systems.

2012-2016 RN Case Management. Per Diem

Los Angeles Care Provider

Los Angeles, California

Case Management responsibilities for home care.

2008-2014 RN Infusion Specialist. Per Diem/Full Time

(Crescent) Walgreens Infusion Services

(Santa Fe Springs, California) Ventura, California

Responsibilities as above including multiple pumps and TPN therapy.

2006-2009 RN Case Management, Full time

Help Unlimited

Ventura, California

Case management responsibilities as above.

2001-2006 Utilization review RN, Anthem Blue Cross

Approx. Newbury Park, California

Skilled RN review of in hospital stay and homecare authorization and evaluation for insurance benefits.

Case Managers perform a function of UM and CM activities demonstrating clinical judgement and independent analysis, collaborating with members, including clinical nurses and treating MDs.

Determines develops and implements the plan of care based on accurate assessment of the member and current or proposed treatment plan in cases of: member inquiry, triage, chronic conditions, multi-pharmacy, prenatal care, and voluntary member health assessment, and indication of multiple monthly emergency room visits.

Apply detailed knowledge of established medical departmental policies, clinical practice guidelines, community resources, contracting and community care standards to each case.

Kristen Pinkerton RN

805-***-****

adwxy9@r.postjobfree.com

0498-1098 Supervisor Clinical: Area from Santa Barbra to Long Beach

Professional Home Health Services

Thousand Oaks, California

Home Care Responsibilities and Duties as below

1992-1998 Supervisor of Specialties: Infusion Therapy, Oncology, AIDS, and Concept

Livingston Memorial Visiting Nurses Association

Ventura, California

Achievements: + Built a 3 RN Specialty Team to a 35 RN Team with 2 assistants

including a second office site

+ Generate MD specific protocols used as standard for their patients

+ Arrange for great speakers to be involved in case conference including

MD’s, pharmacists, new products and specific topic speakers

Specialties needs

Conducts full interviews and hiring and perform full discipline and

termination procedures

Responsibilities: + Create and participate in QA/Utilization Review aspects to specialty

Issue

+ Create new programs to update of specialty care

+ Seek out financial opportunities thus coordination of contracts and

subcontracts

+ Negotiate rates with insurance companies for patient care, including

Medi-Cal and Medicare

+ Participate in clinical decisions and responsibilities in pharmaceutical

Partnerships

+ Acts as a liaison for the organization with referral sources, infusion

Companies and provide with specialty information and instruction

+ Develop specialty policies and procedures

+ Determine staffing needs, reconciles patient schedules and to ensure

Coverage for on call staff

+ Conduct field supervisory visits for evaluation on performance and

Adherence to organizations policies and procedure

BRN CA expires 02/2023

BLS expires 06/2024

Covid vaccination 2 plus booster



Contact this candidate