Utilization Review Nurse with Compliance Expertise
Resume:
April Frazier
Schertz, TX ***** 210-***-**** ****************@*****.*** WWW: Bold Profile
Dynamic Utilization Review Nurse with extensive experience at Ethos, adept at conducting thorough reviews and ensuring compliance with clinical guidelines. Proven ability to reduce healthcare costs through effective resource utilization and strong interpersonal communication skills. Committed to quality improvement and maintaining HIPAA compliance while enhancing patient care outcomes.
• Documentation and reporting • InterQual criteria
• Utilization review • Records analysis
• Interpersonal and written communication • Physician consultations
• Patient care plans • Prior authorization
• HIPAA compliance • Discharge planning coordination
• Inpatient care • Quality improvement
Utilization Review Nurse, 09/2021 - Current
Ethos – Broussard, LA
• Conducted comprehensive utilization reviews to ensure compliance with clinical guidelines.
• Evaluated patient treatment plans for appropriateness and medical necessity.
• Collaborated with healthcare providers to facilitate efficient care coordination.
• Documented review findings in electronic health record systems for accurate reporting. Utilization Review Nurse, 12/2014 - 2016
Nexus Medical Consulting – San Marcos, TX
• Conducted comprehensive utilization reviews to ensure compliance with clinical guidelines.
• Evaluated patient treatment plans for appropriateness and medical necessity.
• Documented review findings in electronic health record systems for accurate reporting. Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
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Professional Summary
Skills
Work History
Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
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Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
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Quality Assurance Nurse Nurse, 01/2016 - 09/2021
Nexus Medical Consulting – Schertz, TX
• Collaborated with healthcare teams to develop and implement care plans.
• Reviewed clinical documentation for accuracy and adherence to regulations.
• Assisted in training staff on quality assurance protocols and best practices.
• Mentored junior staff in quality assurance methodologies and regulatory requirements. Evaluated nursing competencies through regular assessments, identifying areas for professional growth and development opportunities.
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LVN Floor Nurse, 02/2011 - 12/2014
Select Rehabilitation
• Administered medications and monitored patient vital signs to ensure safety and comfort.
• Documented patient assessments and care plans in electronic health record systems for accuracy.
• Assisted with daily living activities, fostering patient independence and well-being.
• Collaborated with interdisciplinary teams to develop and implement effective care strategies.
• Maintained infection control standards, ensuring a safe environment for patients and staff.
• Evaluated patient progress regularly, adjusting care plans as needed for optimal outcomes. LVN Charge Nurse, 08/2007 - 12/2011
Temple Living Center West – Temple, TX
• Supervised nursing staff to ensure high-quality patient care and adherence to safety protocols.
• Coordinated daily shift assignments, optimizing workflow and enhancing team collaboration.
• Monitored patient health status, administering medications and treatments as prescribed.
• Trained new nursing personnel on best practices and facility policies for efficient operations.
• Implemented infection control measures, improving compliance with health regulations.
• Conducted regular assessments of patient care plans, adjusting as necessary for optimal outcomes. Promoted continuity of care by maintaining comprehensive medical records and updating physicians on significant changes in patients'' conditions.
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Treatment Nurse, 03/2008 - 05/2010
Temple Living Center West – Temple, TX
• Administered medications and treatments in accordance with established protocols.
• Monitored patient vitals and reported changes to the healthcare team promptly.
• Assisted in developing individualized care plans tailored to patient needs.
• Educated patients and families on treatment procedures and health management strategies.
• Collaborated with interdisciplinary teams to enhance patient care outcomes effectively.
• Trained new nursing staff on best practices and safety protocols within facility. Provided emotional support to patients coping with chronic or complex wounds that required long-term treatment plans.
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• Educated patients and their families on wound care management, promoting a faster healing process.
• Conducted regular assessments of patients'' wounds to evaluate progress and adjust treatments accordingly. LVN Charge Nurse, 08/2004 - 12/2007
Indian Oaks Assisted Living License – Harker Heights, TX Evaluated nursing procedures for effectiveness, identifying areas for process improvement and training needs.
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• Oversaw patient conditions, administered medicine, performed interventions and took detailed records. Worked with multidisciplinary team to carry out successful treatment plans for diverse acute and chronic conditions.
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Cultivated strong working relationships with physicians by maintaining open communication, providing timely updates on patients'' status, and actively participating in care coordination efforts.
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Facilitated smooth transitions between shifts through efficient handoff reports that highlighted critical information for incoming nurses.
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Promoted a culture of teamwork and collaboration among nursing staff by encouraging the sharing of best practices, learning from one another''s experiences, and supporting each other in challenging situations.
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Licensed Vocational Nursing, 08/2004
Central Texas College - Killeen, TX
Education
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