Utilization Review Registered Nurse/ HEDIS/ Chronic Care Management

September Barylski, RN

810-***-**** *****************@*****.***

Summary: Caring and detailed orientated Registered Nurse with 20 years of clinical background in various acute care settings, with excellent communication skills, self-motivation, and attention to detail. Strong clinical background in nursing with a solid knowledge base, high- level critical thinking skills, and ability to apply evidence-based guidelines during the determination process. Recently completed a Utilization Review and HEDIS training with Remote Learning Services, LLC. Seeking to continue demonstrating abilities and grow with a dynamic team of remote healthcare professionals.

Skills:

●Utilization Review

●Medical/Surgical

●Intensive Care Unit

●Orthopedics/PACU

●Admissions/Intakes

●Prior Authorizations

●Appeals/Denials

●Nursing Mentor

●Medicare/Medicaid

●Emotional Intelligence

Employment History:

●Concurrent Reviews

●HEDIS/Data Abstraction

●Discharge Planning/DME

●Team Collaboration

●Critical Thinking

●Adaptability/Flexibility

●Advanced Organization

●Knowledge of ICD-10

●Time Management

●Microsoft Office Products

RN/Staff, Orthopedics, Surgical Center PACU, 4/2012 - Current

Blue Water Surgery Center, Port Huron, Michigan

●Participates in assessment and readiness for patients having surgical procedures.

●Provided nursing care thorough patient assessment, initiation and discharge from the facility.

●Adaptability – Respond to rapidly changing situations and prioritize tasks efficiently.

●Provide excellent customer service, and maintained HIPAA confidentiality compliance during triage, and guidance for testing and follow-up.

●Demonstrating professionalism and expertise, using exceptional clinical skills and awareness.

●Supported colleagues emotionally through communication and care by being an advocate.

●Instructed patients on procedures while ensuring they were medically cleared for services.

●Maintain open communication with patients and family during the procedure process.

●Worked collaboratively with an interdisciplinary team to provide patient-centered care.

Professional Education:

Utilization Review-101, Certificate of Completion - 9/2024

HEDIS/Data Abstraction, Certificate of Completion - 4/2025

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

St Clair County Community College, Associate’s Degree in Nursing

License: Registered Nurse, Michigan – Current

Contact this candidate