Utilization Review CITC, RCT - Veterans Administration
(2021-06)
- Determined eligibility based on MCG and Medicare guidelines while considering individual veteran circumstances.
- Assessed medical necessity for community care authorization when in-house services were unavailable, adhering to Mission Act directives.
- Reviewed diverse medical needs to ensure comprehensive evaluations for each veteran.
- Processed doctors' orders with accurate coding to expedite veterans' access to necessary care.
- Managed and coordinated care from consult referral through discharge, maintaining thorough records.
- Supported healthcare initiatives at Cheyenne Healthcare System to improve service delivery.
Registered Nurse - Veterans Administration
(2019-09 - 2021-06)
- Registered Nurse working 1:1 with Veterans inpatient for substance abuse.
- Delivered comprehensive healthcare services at Cheyenne Healthcare System to improve patient outcomes.
- Utilized mental health skills, including knowledge and empathy, to support Veterans in their recovery journey.
- Offered tailored solutions to Veterans' diverse needs and intervened effectively during episodes of panic and anxiety.
Registered Nurse - University of Colorado Health
(2016-08 - 2019-06)
Registered nurse at dual diagnosis 40-bed facility.
- Performed assessments, charting, triage of walk-ins, dispensing medications, treatment plans, wound care, blood draws, and lab results; detoxed large numbers of patients using CIWA and COWS protocols, assessed delirium tremors, and responded to seizures.
- Prevented, intervened, and treated many suicide attempts.
- Contributed to interdisciplinary team of psychiatrists, RNs, care coordinators, LPNs, and health specialists to enhance patient care.
- Supervised junior staff, guiding and supporting daily tasks to ensure high-quality patient care.
- Hired to work the nursing intensive unit.
- Performed EKGs and educated staff on their use.
Utilization Review - Harmony Foundation - Estes Park, CO
(2013-02 - 2016-08)
- Reviewed patient cases for insurance approval of treatment days, ensuring compliance with coverage criteria.
- UR included full chart reviews to pull criteria necessary to justify the level of care needed.
- Facilitated appeals between doctors for patients denied coverage, advocating for necessary treatment.
- Successfully managed all doctor-to-doctor reviews, streamlining the appeals process.
- Met with patient clients regularly to address their needs.
- Understood various insurance policies and authorization requirements.
- Applied MCG guidelines for patient care evaluations.
