Utilization Management Specialist with Clinical Expertise

Patricia J Taylor

214-***-**** **********@***.*** Lavon, 75166

SUMMARY

Seeking a stable work environment with proven track record. My military background has taught

me the importance of having a strong work ethic. I excel when trained appropriately in my

assigned work tasks and enjoy challenges in non-routine jobs. While I am not looking for supervisory

or management roles, that does not translate into being non-leadership in my character.

SKILLS

Analytical thinking Quality improvement

Problem solving Time management

Independent work habits Adaptability

Discipline Prior authorization

Mature stability Physician consultations

Assiduous Utilization management

Driven to meet goals Telephonic nursing

Driven to meet milestones Medicare

Utilization review IV management

HIPAA compliance Clinical documentation

Medical documentation Attention to detail

Critical thinking

EXPERIENCE

Utilization Management Specialist, Kelsey-Seybold Clinics, January 2022-Current

Application of CMS/InterQual criteria for Medicare Advantage and commercial referrals.

If unable to meet the criteria, sent requests to MD reviewers for decisions.

Contacting providers and patients with adverse decisions with HIPAA compliant

determinations.

Staff LPN, Banner Hospital, January 2021-January 2022

Sun City, Arizona

Direct patient care of an aging population in a Progressive Care Unit during the height of

COVID hospitalizations.

Utilization Review Nurse, Health Direct Inc, January 2015-January 2020

Received worker compensation requests from Texas providers that could be completed at the

nurse level.

If physician review is needed, immediately work the request up and refer to Peer Review to

remain within the time constraint of Texas law.

Utilization Review Nurse, Corvel Corporation, January 2014-January 2015

Received worker compensation requests from Texas providers that could be completed at the

nurse level.

If physician review is needed, immediately work the request up and refer to Peer Review to

remain within the time constraint of Texas law in workers compensation.

EDUCATION AND TRAINING

Licensed Vocational Training

U.S. Army, Ft. Sam Houston TX January 1975

Some college courses

Nursing, Collin County College

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