Colleen Adams

Personable and dedicated professional with keen eye for detail and passion for ensuring high standards of patient care. Well-versed in healthcare protocols and safety practices, bringing strong organizational and analytical skills. Committed to improving patient outcomes through meticulous attention to procedural compliance and quality control.

Compassionate and collaborative individual with deep understanding of medical care and patient needs. Possesses strong analytical skills and familiarity with healthcare regulations and patient documentation. Committed to improving patient outcomes and optimizing healthcare resources.

Utilization Review Nurse - Axxon Technologies Contractor for Accentra Health

(2026-01)

• Conducted comprehensive reviews of medical records to assess necessity of treatments and procedures.
• Collaborated with healthcare teams to develop and implement utilization management strategies.
• Evaluated clinical data to ensure compliance with established guidelines and protocols.
• Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
• Performed prior authorization review of services requiring notification.
• InterQual Proficient
• Performed Prior Authorizations for DME, Home Health, Inpatient Medical Admissions, Therapy, Hospice

Post-Acute Rehabilitation - PRN - Ignite Medical Resorts - Crown Point, IN

(2025-10 - 2026-01)

Skilled at working independently and collaboratively in a team environment.

• Proven ability to learn quickly and adapt to new situations.
• Demonstrated respect, friendliness, and willingness to help wherever needed.
• Worked flexible hours across night, weekend, and holiday shifts.
• Organized and detail-oriented with a strong work ethic.

UTILIZATION MANAGMENT NURSE - ez URS - Richardson, TX

(2024-07 - 2025-08)

• Quality Assurance Nurse
• Applies clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care.
• Consults with physician advisors to ensure clinically appropriate determinations
• Facilitated interdisciplinary collaboration for the development and implementation of evidence-based practice guidelines, promoting consistency in patient care delivery.
• Mitigated potential legal issues related to improper admission or discharge decisions by consulting with physicians regarding complex cases that required further clarification.
• Implemented continuous improvement program for utilization review process, leading to better healthcare management.
• Evaluated patient histories, complaints, and current symptoms.
• Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.

UTILIZATION REVIEW NURSE - InterCare InterMed Cost Containment Services - Glendale, CA

(2022-10 - 2024-07)

• Utilization Review Nurse
• Review medical history, treatment plan and documentations to identify if medical necessity has been meet and ensure treatments are not over-utilized, safe and meet evidence-based guidelines
• Identifying prior treatments and validating the treatment plan and diagnosis
• Refers, coordinates and interacts with peer clinical reviewers and facilitates peer discussion during peer clinical reviewer processes
• Evaluates need for continued or alternative treatment plan with provider
• Maintains confidentiality and security in all aspects of performance

Associate of Science - Registered Nurse - North Palm College (2026-05)

LVN - Ivy Tech Community College (2007-12)