KIMBERLY SMITH
Crandall
Summary
Achieved improved patient care outcomes through comprehensive utilization reviews over 23 years in healthcare. Enhanced admissions and stay review processes to streamline operations. Strengthened relationships with case managers and providers, resulting in better collaboration. Contributed to team success with exceptional organizational skills and a passion for healthcare.
Overview
26
26
years of professional experience
1
1
Certification
Work History
Utilization Management Nurse
Humana Gulf South Region Medicare
05.2024 - Current
- Evaluated clinical data to determine medical necessity for services and treatments.
- Collaborated with healthcare providers to facilitate appropriate patient care plans.
- Conducted comprehensive reviews of patient records for compliance with guidelines.
- Mentored junior nurses on utilization management protocols and best practices.
Utilization Review Nurse
Humana Ky Medicaid
11.2020 - 05.2024
- Achieved enhanced organizational performance through expert consultation on medical necessity criteria and evidence-based practices in utilization review nursing. Improved discharge planning efficiency by promptly identifying medically stable patients for transition to alternate care levels. Delivered thorough admission reviews for medical necessity based on MCG guidelines. Leveraged EMR systems for streamlined patient management. Maximized productivity using Microsoft Office tools such as Word, Excel, and PowerPoint.
- Mentored junior nursing staff on best practices in utilization management.
- Contributed to organizational success by providing expert advice on medical necessity criteria and evidence-based practices in utilization review nursing.
- Served as a vital liaison between patients, healthcare providers, and insurance companies, fostering effective communication and coordination among all parties involved in the care process.
- Assisted discharge planning efforts through prompt identification of medically stable patients who were ready for transition to alternate levels of care.
Infusion Nurse
Amotec, Inc
01.2011 - 12.2023
- Home Infusion RN PRN, IVIG, Remicade, Chemotherapy
- Enhanced patient comfort by providing compassionate care and administering medications through IV infusion.
- Reduced complications by closely monitoring patients for adverse reactions during infusion therapy sessions.
Registered Nurse
Baptist Health System KY & IN
03.2019 - 11.2020
- Home Health RN, Case Management, Skilled Care, McKesson computer program
- Improved patient outcomes by implementing evidence-based nursing interventions and individualized care plans.
- Reduced hospital readmissions through effective discharge planning, patient education, and follow-up care coordination.
Registered Nurse
1st care Home Health Services
05.2018 - 03.2019
- Home Health RN, Case Management, Skilled Care, Access computer program
- Improved patient outcomes by implementing evidence-based nursing interventions and individualized care plans.
- Reduced hospital readmissions through effective discharge planning, patient education, and follow-up care coordination.
Home Health RN
Caretenders
06.2015 - 05.2018
- KIMBERLY SMITH RN, Crandall, IN 47114, kimmie4277@yahoo.com, (812)989-2147, Authorized to work in the US for any employer, Utilization management, RN Compact Licensure, Home Health RN, Case Management, Skilled Care, Home Care Home Base computer program
- Improved patient outcomes by providing high-quality nursing care and implementing evidence-based practices.
- Enhanced patient satisfaction through effective communication, empathy, and timely response to their needs.
- Collaborated with interdisciplinary teams for comprehensive patient care plans, resulting in better health outcomes.
- Educated patients on disease management and self-care techniques, promoting lifestyle changes for improved health.
Utilization Review Nurse
Humana Veterans
08.2011 - 06.2015
- Utilization Review: coordinated with VA on patients for joint replacement
- Pre surgery, inpatient stay and post surgery rehab coordination
- Patient Care Coordination Skills: care coordination, Post DC calls, assisting members with needs and resources
- Additional: Works well with others, team player, punctual, always willing to learn/ experience new levels of nursing, always willing to help others, dependable, and professional
- Improved patient care quality by conducting thorough utilization reviews and making recommendations for optimal treatment plans.
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Performed prior authorization review of services requiring notification.
- Optimized hospital stays by monitoring admissions for appropriateness based on established clinical guidelines while considering each patient''s unique circumstances.
- Served as a vital liaison between patients, healthcare providers, and insurance companies, fostering effective communication and coordination among all parties involved in the care process.
- Enhanced patient satisfaction by collaborating with interdisciplinary teams to develop individualized care plans, ensuring appropriate level of care.
- Experience with TRICARE contracts, policies, and programs.
- Medical necessity reviews
- MCG experience
Registered Nurse
Clark Memorial Hospital
02.2000 - 08.2011
- Ambulatory Care Services - 11 years, Med-Surgical Nursing-4 Years, IV Therapy-2 years, Team Leader-7 years for Ambulatory Care and Wound Care
- Organized scheduling for patients and employees, billing, inventory, Outpatient Surgery, Endoscopy, Oncology/chemotherapy
- Reduced hospital readmissions through effective discharge planning, patient education, and follow-up care coordination.
- Improved patient outcomes by implementing evidence-based nursing interventions and individualized care plans.
- Oversaw delivery of care for patients on medical-surgical unit, providing direct care, delegating nursing assignments and supervising team comprised of nurses, LPNs, technicians, and unit clerks.
- Educated family members and caregivers on patient care instructions.
- Evaluated patient histories, complaints, and current symptoms.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Monitored patient reactions after administering medications and IV therapies.
- Managed patients recovering from medical or surgical procedures.
Education
Bachelor of Science - Nursing
Spalding University
Louisville, KY01.2024
Associate in Nursing -
Ivy Tech State College
Sellersburg, IN01.2002
LPN - Nursing
Ivy Tech Community College of Indiana
Sellersburg, IN12.2000
Diploma -
Eastern High School
Pekin, IN01.1996
Skills
- Achieved improved patient outcomes through effective case management in hospital settings Delivered safe medication administration and IV therapy, enhancing recovery times Enhanced home health and home care services, resulting in higher patient satisfaction Streamlined EMR systems and medical records management, increasing efficiency Elevated nursing practices in post-operative care and triage, contributing to better patient monitoring Advanced utilization review processes, ensuring optimal resource utilization and care quality
Certification
- BLS Certification
nursing licenses
BSN; Compact 28167466A
Timeline
Utilization Management Nurse
Humana Gulf South Region Medicare
05.2024 - Current
Utilization Review Nurse
Humana Ky Medicaid
11.2020 - 05.2024
Registered Nurse
Baptist Health System KY & IN
03.2019 - 11.2020
Registered Nurse
1st care Home Health Services
05.2018 - 03.2019
Home Health RN
Caretenders
06.2015 - 05.2018
Utilization Review Nurse
Humana Veterans
08.2011 - 06.2015
Infusion Nurse
Amotec, Inc
01.2011 - 12.2023
Registered Nurse
Clark Memorial Hospital
02.2000 - 08.2011
Bachelor of Science - Nursing
Spalding University
Associate in Nursing -
Ivy Tech State College
LPN - Nursing
Ivy Tech Community College of Indiana
Diploma -
Eastern High School