Prior Authorization Regulatory Compliance
Resume:
KATIE R
GAY, BSN RN
*********@*****.***
West Monroe, Louisiana 71291
Compassionate Director of Nursing dedicated to maintaining highest standards of nursing practices and policies. Excellent leader, mentor and recruiter, supporting staff and local community. Demonstrates strong working knowledge of regulatory compliance along with proven results in managerial role. RN dedicated to executing on prescribed medical funding guidelines and policies. Maintains compassionate and sympathetic relations with consumers. Adept at balancing business interests with human-centric service models. Hardworking Prior Authorization Specialist with successful background working closely with private insurance companies, Medicare, and LA Medicaid representatives to gain preapproval for procedures and testing. Detail- oriented performer with over 20 years of managing documentation. Considered team player with exemplary multitasking skills. Organized professional knowledgeable in regulatory standards and compliance requirements. Confident with a background spent working in medical offices, hospitals, and homecare and homehealths communicating effectively orally and through writing and developing prior authorization workflows. Reliable RN with over 20 years of experience working in fast-paced, clinical settings. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
PROFESSIONAL SUMMARY
Americare - RN/Administrator Officer
11/2017 - Current
WORK HISTORY
Coordinated medical and health services in compliance with government regulations and policies set by board of trustees
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Assessed competency of clinical staff to promote quality, continuity and safety
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Reviewed incident reports for accuracy and proper notification to family, physicians and other agencies as required by regulations
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Implemented changes needed to correct deficiencies found during government inspections
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Monitored development, implementation and updates of individualized care plans
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Administered executive supervision, exercising independent judgment to select proper course of action in policies and procedures
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Recruited well-qualified candidates to fill vacancies and offer residents unparalleled care
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Headed clinical oversight to devise and establish policies, procedures and best practices in alignment with regulatory requirements
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Oversaw new nursing employee orientation process, including explanation of personnel policies and individual duties
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• Collaborated with Quality Team to develop outcomes statistics Initiated training and education programs for supporting healthcare staff
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• Solicited medical history information from patients to provide best SKILLS
Multidisciplinary team
collaboration
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• Profitability strategies
• Accreditation coordination
• Patient safety
• Records management
• Regulatory requirements
• Facility oversight
• Patient relations
• Staff supervision
• Hospital coordination
• Acute and rehabilitative care
• Healthcare delivery
• Health information systems
• Schedule management
• Intravenous therapy
• Training and mentoring
• HIPAA Compliance
• Utilization review
• Healthcare regulations
• Care Coordination
• Clinical Documentation
• Insurance Verification
• Performance Improvement
• Medical Billing
• Clinical assessment
• Pharmacology knowledge
• Patient Examination
• Vitals monitoring
• Instrument Sterilization
• Case Management
• Infection Control
• Surgical Assistance
• Student Precepting
• Medical Recordkeeping
• Nursing Consultation
• Documentation
• Direct Patient Care
• Chronic Disease Management
• Treatment Preparation
• Rehabilitation Assistance
• Equipment Sterilization
• Patient Condition Monitoring
• Patient consultation
• Problem-Solving
• First Aid
• Preventive health
• Clear Patient Communication
• Diagnostic Test Ordering
• Analytical Thinking
• Medication and IV administration
• Multitasking Abilities
• Organizational Skills
• Compassionate and Caring
Heartsaver First Aid CPR AED
(First Aid CPR AED)
•
• Problem-solving abilities
• Time management abilities
• Heartsaver CPR AED
• Effective Communication
• Adaptability
• Nursing Performance Assessment
• Oxygen saturation standards
• Intake and discharge
• Team building
• Strong Clinical Judgment
• Critical Thinking
• Interpersonal Skills
• Procedure Room Preparation
• Patient Education
• Preventive Healthcare
• Active Listening
• Patient Care Assessment
• Cardiac monitors
• Decision-Making
• Community Program Referrals
• Professionalism
• CPR/AED
• Self Motivation
• Unit Administration
Blood Draw and Sample
Collection
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United Home Health Care - Transition RN
11/2014 - 11/2017
and most effective medical advice
Trained and qualified staff per board requirements as well as national, state and local regulations
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Created and maintained facility documents and records, maintaining accuracy while managing sensitive data
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Reviewed and assessed staff processes, reducing hazards posed for residents and staff while promoting regulatory compliance
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Led and motivated employees through supervision, training and coaching on duties and daily operational activities
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Formulated and implemented testing and interpretation practices and procedures to maintain standards of care and quality assurance benchmarks
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Worked closely with store manager to maintain day-to-day operations
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Updated procedures necessary for compounding, mixing, packaging and labeling medications.
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Coordinated care with physicians and other clinical staff to prepare for treatment, carry out interventions and enhance continuum of care to deliver comprehensive services
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Monitored and recorded patient condition, vital signs, recovery progress and medication side effects
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Administered medications, tracked dosages and documented patient conditions
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Imparted medical, operational and patient care knowledge to junior nurses to maximize performance and quality of team operations
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Developed and maintained quality care systems and standards, including creating and improving medical protocols and guidelines
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Addressed unit staff concerns, including staffing ratios, resource management, allocation of responsibilities and optimized workload management
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Coordinated and managed care for patients undergoing myocardial infarction screening and anticoagulation therapies
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Assisted patients with healing and recovery after surgery by closely monitoring and caring for wounds, answering questions and educating about continued care strategies
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Met training objectives by instructing new and prospective nursing staff in clinical skills and organizational procedures
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Oversaw patient admission and discharge processes to coordinate efficient movements and related paperwork
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Managed and provided leadership to help staff with direct and indirect patient care and telemetry monitoring
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Advanced nursing competencies through participation in simulation exercises and practice improvement projects
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Administered oral, intramuscular and IV medications to patients and monitored responses
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Boosted clinical accountability and reduced discrepancies by coordinating with other stakeholders to develop and roll out new flow sheet and forms for dialysis treatment
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Trained new RN hires and ancillary staff members to meet patient service goals, champion standards of care and improve patient overall satisfaction
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Cared for patients in recovery from medical procedures by caring for wounds, monitoring vitals and managing pain
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• Team Collaboration
• Home care
• Medication Administration
• Insulin medication assistance
Family planning services
education
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• Training staff
• Analytical Skills
• Wound Care
• Professional Demeanor
• Reliability
• Continuous Improvement
• Acute care expertise
• Strong Organization
• Compassionate Care
• Disability Awareness
• Volunteer Management
• Records Maintenance
• Venipuncture Expertise
• Clinical judgment
Intravenous medication
administration
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• Ethical Practice
• Peripheral IV care
• Fluid Balance Monitoring
• Blood product administration
• Home infusion therapy
• Infusion pump operation
• Nursing Process Application
• IV insertion techniques
• Anatomy knowledge
Total parenteral nutrition
administration
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• IV Medication Administration
Grambling State University
Grambling, LA • 05/2004
Bachelor of Science in Nursing
Administration: Nursing
BSN RN LA 110***-****- CURRENT
Chatham High School
Chatham • 05/1999
Highschool Diploma
EDUCATION
BLS CURRENT History of ACLS/PALS
when working hospital setting.
BLS
Glenwood Regional Medical - Staff Registered Nurse Endoscopy/Discharge RN
04/2004 - 11/2014
Performed blood and blood product transfusions and intravenous infusions to address patient symptoms or underlying causes
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Maintained composure and efficiency during rapid response situation and emergency codes
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Administered IV therapy and treadmill stress tests and ran nerve conduction tests in cardiac unit
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Updated physicians on patient test results and assisted in developing care plans
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Instructed patients, caregivers and families on diagnoses, treatment options and self-management to maintain continuity of care
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Boosted patient outcomes by prioritizing nursing tasks and assignments and accurately reporting on each patient's status
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Assessed patient health needs by reviewing and tracking EKG readings to address telemetry readings and quickly inform teammates on stability or acuity changes
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Planned and spearheaded in-service educational programs focusing on fall safety, skin care and adherence to core measures
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Treated patients suffering from chronic and acute medical concerns, including asthma, seizure disorders and pneumonia
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Immunized patients against influenza and pneumonia to protect vulnerable populations from serious illnesses
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Counseled caregivers and families on end-of-life planning and educated on patient care options
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Cultivated working partnerships with patients and medical staff members, using feedback and clinical data to improve quality care and patient outcomes.
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Answered patient questions and provided take-home materials for further information
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Administered oral, intramuscular and IV medications to patients and monitored responses
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Monitored and educated nursing students and externs on proper care procedures and prioritization strategies
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Reviewed physician orders and participated in medication management to optimize patient safety
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Prioritized patient care assignments based on patient conditions to achieve optimal outcomes
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Reviewed physician orders and administered therapies, treatments and medications
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Monitored and recorded patient condition, vital signs, recovery progress and medication side effects
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• Maintained reports to provide oncoming shift with full patient status Mentored new nurses on practices and procedures to drive patient outcome goals
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Collaborated with interdisciplinary healthcare professionals to create, implement and adapt individualized care plans
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Imparted medical, operational and patient care knowledge to junior nurses to maximize performance and quality of team operations
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Circulated throughout multiple hospital departments to perform nursing rounds
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Explained treatment procedures, medication risks, special diets and physician instructions to patients
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• Promoted healthy lifestyle choices to reduce re-emergence of painful or dangerous symptoms
Used facility EMR system to update patient records, transmit prescriptions and transfer files
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Administered medications, tracked dosages and documented patient conditions
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Facilitated strategic goals aimed at increasing satisfaction and improving outcomes through compassionate, precise and high-quality nursing care
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Monitored patient vitals post-surgery, managed medical equipment and administered medications and IVs
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Addressed rapid response and code situations by strategically organizing and delegating tasks
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Communicated effectively with physicians and provided support during surgical procedures
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Recorded patients' medical history, vital statistics and test results in electronic medical records
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Delivered extensive training to newly hired employees and student nurses, offering insight and assistance related to emergent situations
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Treated patients by administering various types of medications and therapies
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Advised, coached and mentored experienced and student nurses on medical issues, crisis management and appropriate nursing interventions
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Developed and adapted individualized treatment plans according to patient recovery goals
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Developed care plans complete with effective nursing measures to improve patients' mental and physical health
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Coordinated care with physicians and other clinical staff to prepare for treatment, carry out interventions and enhance continuum of care to deliver comprehensive services
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Evaluated patients to develop and update treatment plans while anticipating day-to-day needs
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Treated patients with strokes, head traumas, comas and intracranial hematomas
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Facilitated transition to home care by providing patients with continued care information and discharge instructions
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Conducted patient assessments and diagnostic tests to provide physician with important patient health information
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• Inserted and managed central, arterial and PICC lines Coordinated and led in-services to facilitate nursing leadership development and career growth.
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Assisted physicians in performing complex endoscopic procedures, ensuring patient safety and comfort throughout.
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Contributed to the development of departmental policies and protocols for consistent quality improvement within the facility''s Endoscopy Unit.
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Meticulously maintained endoscopic equipment in line with manufacturer recommendations, ensuring optimal performance during procedures.
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Established strong rapport with patients undergoing invasive procedures, alleviating anxiety levels before commencing treatments.
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Enhanced patient satisfaction by providing compassionate and individualized care during endoscopy procedures.
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Demonstrated commitment to professional development by attending industry conferences and workshops related to endoscopy
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nursing practices.
Actively participated in quality assurance initiatives pertaining to endoscopic services, leading to continuous improvements in patient care delivery systems.
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Maximized staff productivity by offering guidance on best practices in the field of endoscopy nursing.
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Ensured accurate documentation of endoscopy findings for timely diagnosis and treatment plans.
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Maintained a sterile environment, adhering to infection control guidelines and reducing the risk of crosscontamination.
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Applied advanced nursing skills to handle emergency situations during endoscopic procedures calmly and effectively.
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Educated patients on post-procedure care, increasing adherence to discharge instructions and promoting overall wellbeing.
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Conducted comprehensive pre-procedure assessments encompassing detailed history taking and physical examinations to identify potential contraindications.
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Participated in ongoing cross-training initiatives to expand skill sets and provide support across various functions within the nursing team.
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Served as an effective liaison between patients'' families or caregivers regarding procedural updates while maintaining strict confidentiality standards.
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Improved patient flow through efficient scheduling coordination with physicians'' offices, resulting in reduced wait times for appointments.
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Streamlined workflow by effectively managing supplies inventory and maintaining organized storage areas.
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Managed sedation administration for optimal pain relief during clinical sessions while monitoring vital signs closely.
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Collaborated with multidisciplinary teams to optimize patient outcomes before, during, and after endoscopic procedures.
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Reduced procedure times by efficiently preparing patients, rooms, and equipment for endoscopic examinations.
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Reported findings to quality departments after conducting routine restraint audits and worked with team to devise corrective actions for deficiencies.
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Observed and documented patient factors such as diets, physical activity levels, and behaviors to understand conditions and effectively modify treatment plans.
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Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
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Leveraged feedback and process improvement opportunities to create safer and healthier environment and increase patient satisfaction.
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Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.
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Worked with healthcare team to develop new dialysis treatment flow sheet and other log forms, improving clinical documentation and accountability.
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Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
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Performed triage on incoming patients and determined severity of injuries and illnesses.
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VieMed - RN Team Leader Covid/Flu Vaccination Project Lafayette, LA • 12/2022 - 05/2023
Participated in evidence-based practice project implementation, nursing competency development and nursing simulation activities.
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Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
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Collaborated with leadership to devise initiatives for improving nursing satisfaction, retention and morale.
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Communicated with healthcare team members to plan, implement and enhance treatment strategies.
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Led teams in driving successful patient outcomes by prioritizing standard of care and best practices.
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Recorded details regarding therapies to keep patient charts updated.
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Explained course of care and medication side effects to patients and caregivers in easy-to-understand terms.
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Delivered high level of quality care to diverse populations while overseeing patient admission and triaging based on acuity and appropriate department admission.
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Provided skilled, timely and level-headed emergency response to critically-ill patients.
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Implemented care plans for patient treatment after assessing physician medical regimens.
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• Managed patients recovering from medical or surgical procedures. Educated family members and caregivers on patient care instructions.
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Equipped patients with tools and knowledge needed for speedy and sustained recovery.
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Investigated and resolved issues affecting hospital operations and patient care.
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Sustained quality standards by performing routine medication audits and upholding internal and industry best practices.
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Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
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Provided exceptional care to high-acute patients needing complex care such as ventilator management, extensive wound care and rehabilitation.
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Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities.
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Performed frequent checks on life support equipment and made necessary adjustments to preserve optimal patient conditions.
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• Evaluated patient histories, complaints, and current symptoms. Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
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Promoted patient and family comfort during challenging recoveries to enhance healing and eliminate non-compliance problems.
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Evaluated staff performance regularly, providing constructive feedback for continuous professional growth.
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Participated in quality improvement initiatives, contributing to improved standards of care across the facility.
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Advocated for patients'' needs during interdisciplinary meetings, ensuring optimal outcomes throughout their stay.
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Reduced medication errors by implementing a double-check system for medication administration.
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Mentored new nurses, providing guidance on clinical skills and professional development.
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Developed strong relationships with patients'' families, supporting them through challenging medical situations.
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Managed staffing schedules to ensure adequate coverage while maintaining budgetary constraints.
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Collaborated with interdisciplinary teams to develop comprehensive care plans tailored to individual patient needs.
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Promoted a culture of safety by consistently adhering to infection control guidelines and advocating for proper equipment use.
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Increased patient satisfaction ratings by fostering a compassionate environment and addressing concerns promptly.
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Maintained accurate documentation of all clinical activities according to regulatory requirements.
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Led continuing education sessions for staff members on relevant topics such as wound care techniques and infection prevention strategies.
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Supported organizational goals by participating in recruitment events and representing the nursing department at community outreach functions.
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Improved communication among team members through regular meetings and collaborative problemsolving.
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Delegated tasks effectively based on team member strengths, maximizing efficiency within the unit.
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Coordinated efficient patient discharge planning, resulting in reduced hospital readmissions.
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Implemented strategies for pain management, leading to increased patient comfort and well-being during recovery.
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Streamlined patient admission process, ensuring timely care and reducing emergency room wait times.
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Conducted thorough assessments of patients'' conditions upon admission, establishing appropriate priorities for treatment.
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Organized and managed care of patients undergoing various therapies and procedures.
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Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
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Updated patient charts with data such as medications to keep records current and support accurate treatments.
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Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
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Monitored patient condition by interpreting and tracking EKG readings, identifying irregular telemetry readings and updating team members on changes in stability or acuity.
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Provided direct patient care, stabilized patients, and determined next course of action.
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Implemented medication and IV administration, catheter insertion, and airway management.
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Managed quality care for patients with heart failure, end-stage renal disease and coronary artery disease.
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Maintained quality care and comfort for patients with heart failure, pulmonary hypertension, and other conditions.
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Contributed substantially to successful department JCAHO accreditation by consistently operating to highest standards of care.
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Administered medications via oral, IV, and intramuscular injections and monitored responses.
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Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.
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Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
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Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
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Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use, and disease management.
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Provided didactic and clinical instructions to orient new nurses and potential student nurses to achieve training outcomes.
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• Managed care from admission to discharge.
Participated in nursing simulation activities, evidence-based practice project implementation and competency development to further nursing education.
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Orchestrated quality-driven, cost-effective care in high-volume trauma setting.
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Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
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• Audited charts and reviewed clinical documents to verify accuracy. Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
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Oversaw delivery of care for patients on medical-surgical unit, providing direct care, delegating nursing assignments and supervising team comprised of nurses, LPNs, technicians, and unit clerks.
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Provided exceptional care to high-acute patients needing complex care such as ventilator management, extensive wound care and rehabilitation.
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Assisted in training new vaccinators on proper techniques and protocols, ensuring a high level of competence and adherence to best practices.
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Demonstrated excellent communication skills when interacting with diverse patient populations, fostering trust and alleviating anxiety regarding the vaccination process.
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Promoted positive public health outcomes through active participation in community outreach events designed to increase awareness about COVID-19 vaccinations.
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Coordinated with local public health officials to ensure accurate and timely reporting of vaccination data for tracking purposes.
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Provided support to other healthcare professionals involved in the vaccination process by sharing knowledge and expertise in administering COVID-19 vaccines safely and effectively.
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Conducted post-vaccination follow-ups with patients as needed, monitoring their health status and answering any questions or concerns they may have had after receiving the vaccine.
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Increased patient satisfaction by delivering efficient and accurate COVID-19 vaccinations in a timely manner.
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Ensured proper vaccine storage and handling, maintaining the efficacy of doses administered to patients.
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Streamlined appointment scheduling process for vaccination clinics, reducing wait times and improving overall efficiency.
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Implemented infection control measures during vaccine administration, reducing the risk of exposure to COVID-19 for both
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staff and patients.
Adhered to strict safety protocols during vaccine administration, minimizing potential risks for patients.
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Continuously monitored vaccine supply levels and expiration dates, minimizing waste and optimizing resource utilization at vaccination clinics.
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Maintained detailed records of vaccinations administered, ensuring accurate reporting for public health purposes.
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Educated patients on the importance of vaccination, addressing concerns and providing accurate information about possible side effects.
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Contributed to ongoing quality improvement initiatives by providing feedback on processes and procedures related to vaccine administration.
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Assisted in coordinating vaccine distribution efforts, effectively allocating resources and managing supplies for optimal clinic performance.
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Stayed up-to-date on evolving guidelines for COVID-19 vaccines, applying current best practices when administering doses to patients.
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Developed effective strategies for managing clinic flow at high-volume vaccination sites while prioritizing patient care.
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Enhanced patient experience by creating a comfortable environment for COVID-19 vaccinations, addressing individual needs and concerns with empathy.
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Collaborated with healthcare team members to manage high-volume vaccination clinics, resulting in smooth operations and minimal wait times.
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Managed situations in compliance with legal requirements and with minimal risk to patient and institution.
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Completed screening questions with patients following CDC guidelines.
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• Wore face mask, eye protection, medical gloves and PAPR. Administered vaccinations via intramuscular injection and completed proper documentation.
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Scheduled tests and procedures for patients needing additional or specialized care.
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Prepared laboratory specimens for testing, obtained results and notified patients of findings.
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Assisted physicians with completing medical procedures and treatments.
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Educated patients on preventive healthcare strategies and at-home care.
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• Upheld correct protocols for infection prevention and control Administered pharmacologic and non-pharmacologic treatments to address patient concerns.
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Assisted with patient with limited mobility by offering exercises, advice and assistive devices.
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Assessed patient history to identify concerning symptoms, diagnose concerns and develop tailored treatment plans.
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Administered medications and assessed patient responses, adjusting strategies to meet objectives.
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Monitored vital signs and documented details for informational and treatment purposes.
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Maintained safe and sterile environment for optimum patient treatment.
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Americare - Prior Authorization Nurse
Monroe, LA • 11/2017 - Current
Collaborated with other healthcare professionals to develop comprehensive care plans.
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Worked closely with case managers to facilitate appropriate utilization of healthcare resources through the prior authorization process.
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Demonstrated commitment to professional development by participating in ongoing training opportunities related to the field of Prior Authorization nursing.
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Mentored new hires within the team, sharing expertise in navigating complex insurance guidelines and best practices for managing workflow efficiently.
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Developed strong relationships with insurance representatives, facilitating effective communication and expediting resolution
Contact this candidate