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Linda
williams.linda77@yahoo.com
813-312-8265
13289 Arbor Pointe Circle Apt. 101.
Tampa, FL 33617
Licensed Utilization Review Nurse
12 years experience W2
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Summary

  • A 17 year highly motivated Nurse seeking a position with opportunities to utilize learned skills and maintain a role as an advocate for members to ensure quality care and assist providers in Healthcare, Call Center and or Health Plan Environment to include Coordinator of needs/request, problem resolution, training and educational needs for members and providers.
  • Committed Licensed Practical Nurse with an 11-year history in the Clinical Utilization Management Department as a Review Nurse Sr and Review Nurse Team Leader in a Healthcare Call Center and Health Plan Environment.
  • Nurse Lead role 2 years for multiple markets reviewing cases for medical necessity working closely with Case management and Medical Director.

COMPUTER/PROGRAM SKILLS: Windows 8-10, MS Word, ACCESS, PowerPoint, Excel and Outlook, Electronic Health Records.Facets, Compass, Interqual, Fax II, Fax Admin, Right Fax, Excel, Webex, MDR Data Base, Macess Que, Macess Extension, McKesson Interqual, Well Point Medical policies, Apollo, AIM, Aetna CBP’s and Milliman, AHCA-Florida Handbook.

Experience
Licensed Utilization Review Nurse Sr. FL/Health Plan
Healthcare
Apr 2013 - May 2021
Tampa, FL

Nurse Phone/Fax reviews and Team Leader for several State Markets and Nurse and Processes Training.

  • Recent work from home role as Licensed Utilization Review Nurse Sr/Care Coordination Department, Florida Health Plan 7 years, performing expedited/regular Utilization reviews for medical necessity, working closely with Medical Directors on a day to day basis dealing with Denials, Approvals, and Partial Approval sent via faxes to providers after post medical directors review. Work telephonically when needed, via Macess Ques/Facets-UM Inquiry and Fax II Ques. Provide education as needed and problem resolutions to members, providers/provider representatives.
  • Previously maintained Team Leader/Utilization Review in the Florida Nurse Call Center at Amerigroup/Anthem/Simply Healthcare. Nurse Lead role 2 years for multiple markets reviewing cases for medical necessity working closely with Case management and Medical Director.
  • Facilitated training of associates via classroom and Webex: Fax II New Process refresher, Facets Nurse Refresher Course, Compass Training and New Hire OJT-One on One, Subject Matter Expert, Coaching and Mentoring as Team Leader via one-on-one contact/email and Utilization management.
Case Management Nursing Utilization Review
Remove Skill
-Licensed Utilization Review Nurse Lead/Medical Management-Nurse Call Center.
Healthcare
May 2004 - Apr 2013
Tampa, FL
  • 07-2011 - 04-2013 AMERIGROUP/WellPoint
    Licensed Utilization Review Nurse Lead/Medical Management-Nurse Call Center
  • 10-2009 – 07-2011 AMERIGROUP
    Call Center Nurse/Medical Management-NCC
  • 10/2008 – 9/2009 LAKESHORE VILLAS HEALTH AND REHABILITATION
    Licensed Practical Nurse
  • 5/2004 – 7/2007 JAMES A. HALEY VETERANS HOSPITAL
    Licensed Practical Nurse
LPN Nursing Utilization Review
Remove Skill
Edit Skills
Non-cloudteam Skill
Education
Attended in Licensed Practical Nursing-LPN
ERWIN HIGH TECHNICAL CENTER, 2003 - 2004
High School Diploma in High School Diploma
HENRY BREWSTER TECHINAL CENTER 1991
High School Diploma in 3 years
CHAMBERLAIN HIGH SCHOOL, 1986 - 1989
Attended in Nursing (RN)
HILLSBOROUGH COMMUNITY COLLEGE
Certifications
Licensed Practical Nurse LPN
Gerontology
James A. Haley Veterans, 2005
National Honor Society
Erwin High Technical Center, 2003
Certified Professional in Healthcare Management
AMERIGROUP TAMPA, 2011
Learners Champion Workshop/ Certified Learning Champions Foundation
AMERIGROUP, 2012
Skills
Nursing
2021
17
Utilization Review
2021
17
Case Management
2021
8
LPN
2013
8