Utilization Review Care Manager

Kathy Tucker, RN

772-***-**** ***************@***.***

Summary: Detail-oriented Compact Licensed RN with a demonstrated clinical background, excellent communication skills, and recently obtained Medicare Care Manager, HEDIS and Utilization Review training and experience with Remote Learning Services. I pride myself on having a solid knowledge base, high- level critical thinking skills, and ability to apply evidence-based guidelines during the determination process. My background in Medical/Surgical, ICU-Dialysis, Acute-Rehabilitation and MDS/LTC Nursing has given me the foundation needed in UR/UM and Care/Case Management. Skills:

● Utilization Review

● Medical/Surgical

● PACU, Pre Post-Op

● Acute-Rehabilitation

● Acute Dialysis

● Admissions/Intakes

● Medicare/Medicaid

● Time Management

● Knowledge of ICD-10

● Critical Thinking

Employment:

● Chronic Care Management

● Retrospective Reviews

● HEDIS/Data Abstraction

● Precertifications/Auths

● Adaptability/Flexibility

● Remote Patient Monitoring

● Motivational Interviewing

● Health/Wellness Coaching

● Discharge Planning/DME

● Microsoft Office/Excel

RN/Staff, PACU, Surgical Services, 12/2019 to 12/2024 USPI, Jensen Beach, FL and Palm Beach Gardens, Fl

● Facilitated communication between patient, staff and physicians to provide positive outcomes.

● Educated patients about surgical procedures, medication regimens, and care post-operative.

● Utilize the nursing process in assessment, planning and the implementation of services.

● Provided direct patient care for medically complex patients with multiple comorbidities.

● Upholds outstanding customer service benchmarks while delivering quality services. RN/Staff, PACU, Surgical Services, 8/2021 to 7/2023 Jupiter Medical, Jupiter, FL

● Strong ability to multi-task and problem solve, A highly respected member of the clinical team.

● Maintain patient safety and evaluate status for positive patient outcomes and quality care.

● Keep all company systems and data, (including sensitive patient data), secure and safe, according to company’s data and security policies and HIPAA guidelines RN/Staff, PACU, Surgical Services - Contract, 5/2021 to 9/2021 Sunbelt Staffing/Travel Nurse

● Staff relief contract, travel assignment for PACU. RN/Staff, PACU, Surgical Services, 9/2017 to 10/2019 HCA Lawnwood Hospital

● Participated in post-op care of patients to facilitate quick and safe patient recovery.

● Works independently, prioritizing tasks, and adjusts priorities with critical thinking skills. RN/Staff, ICU/Dialysis, CCU/Dialysis, 4/2015 to 2/2019 Davita Dialysis, Hospital Acute Care Program

● Managed dialysis patient care across a broad range of ICU and CCU patient populations.

● Utilized the nursing process to develop care plans and advanced care planning.

● Assisted in the wellness coaching of preventative health options to patients/families. RN/Staff, MDS Coordinator/ADON - Acute Rehab, 10/2013 to 4/2015 Life Care Rehabilitation Hospital

● Responsible for assessments, admissions, evaluations, teaching and monitoring of patients.

● Ensure accurate completion of MDS assessments to meet Medicare and Medicaid regulations. Professional Education:

Utilization Review-101, Certificate of Completion - 12/2024 Medicare Chronic Care Management, Remote Patient Monitoring: Certificate - 2/2025 HEDIS/Data Abstraction: Certificate of Completion - 2/2025

● Remote Learning Services, LLC, taught by Marie Peppers LPN and Judy Clarke, RN ASN/Associate Degree in Nursing, Pasco-Hernando State, Port Richey, FL License: Registered Nurse, Florida, Compact, Current - RN2060292

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