Registered Nurse Utilization Review
Resume:
Rosie Settle
Registered Nurse
317-***-**** *****@******************.*** Bradenton, Florida Professional Summary
Highly experienced Registered Nurse with 30+ years of expertise in Newborn Nursery, Neonatal Intensive Care (Level III & IV), and Pediatrics. Proven ability to manage complex patient cases, collaborate with multidisciplinary teams, and advocate for optimal patient outcomes. Seeking to leverage clinical expertise and strong analytical skills in a Case Management or Utilization Review role.
Key Skills & Abilities
● Patient Assessment & Care Planning: Comprehensive skills in evaluating patient needs, developing individualized care plans, and coordinating services to achieve desired outcomes.
● Care Coordination & Collaboration: Extensive experience working with physicians, social workers, therapists, and other healthcare professionals to ensure seamless care transitions and effective resource utilization.
● Utilization Review: Knowledge of medical necessity criteria and level of care determinations. Adept at reviewing patient records, identifying potential issues, and recommending appropriate interventions.
● Medical Record Review & Documentation: Proficient in reviewing and interpreting complex medical records, documenting patient progress, and ensuring compliance with regulatory standards.
● Advocacy and Communication: Strong advocate for patients and families, with excellent communication and interpersonal skills to effectively interact with diverse populations and navigate challenging situations.
● Critical Thinking & Problem Solving: Ability to analyze complex situations, identify root causes, and develop effective solutions to optimize patient care and resource utilization.
● Disease Management: Deep understanding of chronic conditions, including Cystic Fibrosis, and experience in developing strategies to promote patient self-management and prevent complications.
● Neonatal and Pediatric Expertise: Specialized knowledge in the care of newborns, including premature infants with complex diagnoses (e.g., NEC, IVH, RDS, HIE), and pediatric patients with diverse medical needs. Professional Experience
Registered Nurse – Neonatal Intensive Care (Level III), Newborn Nursery, Pediatrics Wishard Memorial Hospital / Eskenazi Hospital, Indianapolis, IN January 1994 – February 2024
● Managed the care of critically ill newborns and pediatric patients, including assessment, planning, implementation, and evaluation of treatment plans.
● Collaborated with physicians and other healthcare professionals to coordinate patient care, ensure timely interventions, and optimize resource utilization.
● Educated patients and families on treatment plans, medications, and home care needs, promoting patient engagement and adherence.
● Monitored patient progress, identified potential complications, and implemented appropriate interventions to achieve desired outcomes.
● Documented patient information accurately and comprehensively in the electronic health record.
Registered Nurse – Pediatrics
Clarian North Medical Center, Carmel, IN
June 2009 – December 2010
● Provided direct nursing care to pediatric patients with various medical conditions.
● Worked on a team to assess patient needs, develop care plans, and implement interventions.
Registered Nurse – Neonatal Intensive Care (Level IV) Methodist Hospital, Indianapolis, IN
May 1995 – November 1997
● Provided specialized care to critically ill newborns, including those requiring advanced respiratory support, hemodynamic monitoring, and complex medical interventions.
Legal Nurse Consultant
RLS Consulting Group, LLC, Bradenton, FL
Owner / Consultant
● Analyzed medical records to identify deviations from the standard of care and assess potential liability in medical malpractice cases.
● This experience demonstrates skills in medical record review, analysis, and critical thinking, all of which are transferable to Case Management/Utilization Review. Education
Bachelor of Science in Nursing – Indiana University LNC Accelerator Mentorship & Business Program – SELNA Consulting, LLC Certifications & Licenses
Registered Nurse – Active License
Basic Life Support (BLS)
Neonatal Resuscitation Program (NRP)
Pediatric Advanced Life Support
Certified Breastfeeding Specialist
S.T.A.B.L.E. Program
Contact this candidate