RN Utilization Management
Resume:
Jennifer A. Eskola-Nicholson
***** ***** *** ** *, Puyallup, WA 98374
*******************@***.***
Objectives
Utilize my knowledge and experience working for Managed Care Company. Maintain my skills in Utilization Management. Support a team with positive implementation of ongoing changes that face us every day.
Education
June 1979 | Diploma in Nursing
Well rounded nursing career from Charge Nurse 32 bed Surgical Floor, Trauma/Medical/Surgical/Burn ICU, to Nurse Coordinator Epilepsy Monitoring, Drug Research, and published. Hyperbaric and wound care, which all tied along with Home Health Care and Utilization Management/Managed Care.
Experience
September 2009 – present | Clinical Review Specialist | Qualis Healthcare | 10700 Meridian Ave. N, Suite 100, Seattle, WA 98133
On-Call/Per Diem | Assesses the medical necessity and quality of healthcare services by conducting prospective, concurrent, and retrospective utilization management reviews for one line of business or contract. Worked with other managers in collecting data for focus studies on Medicaid cases.
June 2005 – November 2007 | Utilization Management Supervisor
Triwest Healthcare Alliance | 1501 Market ST, Tacoma, WA 98444
Responsible for the supervision and management of the UM Process. Lead the UM clinical and non-clinical staff in maximizing successful compliance with contractual referral and authorization requirements. Act as subject matter expert on knowledge of managed care for staff doing medical necessity reviews and the care coordination process. Education of where to find resources, how to find the policies and procedures for a good review. Assisting the staff to set goals for themselves, the following year, with performance improvement plan. Importance of a supervisor to be available and the staff to know they were important and always welcome to ask questions. Constructive criticism, positive comments were extremely important for staff morale.
May 2004 – June 2005 | Utilization Management Specialist
Triwest Healthcare Alliance | 1501 Market ST, Tacoma, WA 98444
Responsible for accurately reviewing authorizations and referrals requiring medical necessity reviews. Utilized ITQ, Clinical decision support tools, and Tricare Policy.
Sept.2001 – May 2004 | Utilization Management Specialist
Healthnet Federal Services | 3600 Port of Tacoma, Tacoma, WA
Medical necessity review, sending cases to Medical Director with the correct information needed for a decision
Feb.1999-Dec.2000| Home Health Nurse
Good Samaritan Home Health and Hospice | 407 14th Ave, Puyallup, WA 98371
Responsible for making skilled nursing visits to medical, surgical and hospice clients that were homebound. 60-70% wound care, with updated case management and patient education every visit. All plans of care approved by attending MD.
Nov.1997-Nov.1998 | Home Health Nurse
Columbia Home Health Agency | 412 Clark St. Pasco, WA 98424
Responsible for making skilled nursing visits to medical, surgical and hospice clients that were homebound. Developed plan of care in conjunction with the MD. After working in a Hyperbaric and wound care clinic this made Home Health a perfect fit for clients that could not get into the clinic on a daily basis. My assessment skills for any type of diagnosis had to be the eyes and ears of the MD.
Nov.1996-Nov.1997 | Nurse Coordinator-Hyperbaric Unit
Sechrist Clinical Services | Kadlec Medical Center, Richland, WA
Responsible for clients needing wound care and hyperbaric therapy. Supervision and clinical monitoring of clients during hyperbaric. Learning from MD that saw our clients daily taught me how hyperbaric can really assist in using hyperbaric along with good wound care and daily assessment and debridement by an MD good outcomes and shorter healing times for this combination of therapies.
April 1992-Nov.1996 | Nurse Coordinator-Research Coordinator-EMU
St. Joseph Hospital and Medical Center, Barrows Neurological Institute, 300 W Thomas Rd, Phoenix AZ
Responsible for managing epilepsy patient’s inpatient and outpatient for monitoring and drug studies. Managed 5 bed EMU with clinical, non-clinical and EEG staff members.
Feb.1987-April 1992 | Charge Nurse Neurological
St.Joseph Hospital and Medical Center, Barrows Neurological Institute, 300 Thomas Rd, Phoenix AZ
Responsible for managing 14 bed Neurological ICU in Level 3 Trauma
Sept.1980-Jan.1987 | Assistant Nurse Manager-Surgical ICU
University of California, Irvine, 100 City Blvd. Orange CA
Responsible for managing the care of trauma, medical and surgical patients at a Level 3 Trauma Center.
SKILLS
Managed Care, ITQ, CPT, ICD-9, Utilization Management, Medical Necessity Reviews
Critical Care, IV Therapy, Research, Drug Studies, Epilepsy Monitoring
Hyperbaric Medicine, Home Health, Hospice, MS Office, Windows
PRESENTATIONS and Publications
1. Patient Awareness of Seizures, D.E. Blum, J. Eskola, and R.Fisher: Neurology 1996, 47:260-264. (Also presentation 1994 Epilepsy Annual Conference)
2. Sensitivity and Specificity of Paired Capillary Prolactin Measurement in Diagnosis of Seizures, T. Ehsan, R. S. Fisher, D. Johns, R. Lukas, D. Blum, and JA. Eskola; Journal of Epilepsy, Vol. 9, No. 2, 1996
3. An Open Label Pilot Study of Oxcarbazepine for Inpatients Under Evaluation for Epilepsy Surgery, R. Fisher, J.A. Eskola, D. Blum, J Kerrigan, B. Duncan; Neurology, April 1995
References on request
Contact this candidate