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Clinical Nurse Auditor

Clinical Nurse Auditor - Adreima

Bessemer, AL

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Motivated, personable business professional. Diplomatic and tactful with professionals and non-professionals at all levels. Accustomed to handling sensitive, confidential records. Demonstrated use of intraqual guidelines. 
Flexible and versatile - able to maintain a sense of humor under pressure. Poised and competent with demonstrated ability to easily transcend cultural differences. Excellent team-building skills.

Work Experience

Clinical Nurse Auditor

Adreima
-
Phoenix, AZ
-

December 2016 to Present

Utilizing MCG Criteria for determination of inpatient versus outpatient status regarding patients. Communicating with the medical director or a secondary reviewer, regarding status recommendation. Corresponding closely with physicians regarding patient status and the physician's plan of care

Registered Nurse

UAB Medical West
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Bessemer, AL
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2005 to Present

Worked in the Medical Intensive Care Unit as a staff nurse caring for pre and post surgery patients. Calculating and administering critical care medication. Assisting with procedures, utilizing critical thinking and decision-making. Performing physical assessments, monitoring lab values and reporting any abnormal finding to physicians.

Registered Nurse

UAB Medical West
-
Bessemer, AL
-

2001 to Present

Adunct Professor for Medical Assistance, Lecturer for Anatomy and Physiology and Medical Terminology

Virginia College
-
Birmingham, AL
-

January 2015 to October 2016

Birmingham, Al Campus 
 
Adunct Professor for Medical Assistance, Lecturer for Anatomy and Physiology and Medical Terminology, Clinical Instructor for RN Student 
 
Lecture and clinical instructions for medical assistants, as well as lecture for regarding adult, geriatrics and pediatric patients, information included diseases and treatment modalities for the various age groups, teaching proper techniques regarding ECG's specimen collection, vital sign measurement, CPR and other clinical techniques needed for patient care, to include being comfortable with patient contact.

Clinical Care Coordinator

Medmanagement, LLC
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Vestavia Hills, AL
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May 2012 to 2015

Performing pre-certification, conducting admission and concurrent review, level of care reviews, clinical audits and outcome evaluation. Chart reviews for special projects. Performing first level reviews, communicating with physician advisors, medical director and clinical service directors to ensure medical necessity for the appropriate level of care. Gathers data for secondary reviews, preparing cases for the Appeal Process

Case Manager

UAB Medical West
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Birmingham, AL
-

2006 to 2011

Concurrent, retrospective and telephonic reviews for in-hospital stay. Utilizing Intraqual guidelines. Patient Advocate Participating in Ethics meeting frequently. Corresponding closely with various health plans and other health care professionals to coordinate patient care. Utilizing ECIN for discharge planning needs. Coordinating discharge planning with various facilities and agencies. Determining inpatient versus outpatient status,

Utilization Reviewer/Precertification

Medwatch LLC
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Lake Mary, FL
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2003 to 2006

Concurrent reviewer for in-hospital stay. Precertify for specialist visits, hospital stay, surgery and other diagnostic testing. Utilizing Milliman and Robertson Guidelines. Corresponding closely with various health plans and other health care professionals to coordinate patient care. 
Computer experience includes: Microsoft Word, Excel, and Med Web.

Registered Nurse

UAB Medical West
-

2001 to 2005

Worked in the Medical Intensive Care Unit as a staff nurse caring for pre and post surgery patients. Calculating and administering critical care medication. Assisting with procedures, utilizing critical thinking and decision-making. Performing physical assessments, monitoring lab values and reporting any abnormal finding to physicians. Patient care delivery for the intensive care setting.

Lecture/Clinical Instructor

Bessemer State Technical College
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Bessemer, AL
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2001 to 2003

LPN Clinical Instructor in the lab setting regarding nursing responsibilities/duties; medication administration, bathing, transferring, admission and physical assessment of the patient. Lectures regarding the nursing process, documentation and nursing fundamentals. 
Assisting LPN students in the clinical setting with nursing responsibilities.

Tele-Management Nurse

Unity Health Management Services
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Birmingham, AL
-

1997 to 2000

Assess the quality and appropriateness of post-discharge care and services. 
Triage patient calls, making appropriate interventions to prevent avoidable hospitalization and other high cost services. 
Works closely with various health plans, physicians and other health care professionals to coordinate patient care. 
Excellent communication skills. Which fosters an effective relationship with the patients.

Registered Nurse

BMC-Princeton
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Birmingham, AL
-

1993 to 1997

Worked in the cardiac catherization lab, where I performed Per and Post assessments of patients having various examinations. Assisted with procedures such as cardioversions, Trans-esophageal Echocardiogram (TEE), Echocardiograms, and Pericardialcentesis. Performed 12- Lead EKG's. Assisted with high-risk cardiac catherizations, worked closely with physicians and radiology technicians. Prepared and infused critical care medications. Administer sedative and reversal medications.

Registered Nurse

St. Vincent's Hospital
-
Birmingham, AL
-

1986 to 1993

In CCU working with Post-Open-Heart Surgery and other critical care patients. Charge nurse and Unit Advisor on the Cardiac Step-Down Unit.

Education

Masters of Health Services Administration in Health Services Administration

Strayer University Washington
-
Washington, DC

2012

B.S. in Nursing

Samford University
-
Birmingham, AL

1991

Nursing obtained

Samford University
-
Birmingham, AL

1985

Skills

Medical Terminology (10+ years), Nursing Educator (10+ years)

Certifications/Licenses

ACLS

June 2017

BLS/CPR

June 2017

Additional Information

Skills Summary 
 
◆ Use of Intraqual 
◆ Use of Milliam and Roberts 
◆ Microsoft Word 
◆ Working knowledge of Excel 
◆ Sharepoint 
◆ General Office Equipment 
 
◆ Blackboard 
◆ Powerpoint Presentations 
◆ Customer Service 
◆ Achieved Level 3 ACE Clinical Ladder 4 years 
◆ Certified Case Manager 
 
◆ Professional Presentations 
◆ Education/Teaching skills 
◆ ACLS Instructor 
◆ LPN Instructor 
◆ Patient Advocate