Ann Holden
Columbia,TN
Summary
Highly experienced and versatile LPN with 30 yrs of expertise in utilization review, patient care, and surgical nursing , and family care nursing. Adept at combing clinical knowledge with administrative acumen to deliver exceptional patient outcomes and ensure compliance with healthcare standards. Skilled in evaluating medical necessity, coordinating care plans, and advocating for patients across diverse settings. Demonstrates a commitment to quality improvement , healthcare compliance, and fostering collaboration within interdisciplinary teams. Expertise in handling complex cases, including high risk pregnancy, and geriatric patients. Strong background in chronic disease management and preventive care.
Overview
22
22
years of professional experience
Work History
Nurse
Shift Key
TX
02.2021 - 01.2024
- Performed accurate documentation of patient assessments, interventions, and outcomes in compliance with regulatory standards.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Assessed patients' temperature, pulse, and blood pressure and recorded in electronic medical records.
- Delegated tasks effectively, optimizing staff productivity and maintaining a well-organized nursing unit.
Charge Nurse LPN
Tradition of Brentwood
Brentwood, Tn
09.2020 - 02.2021
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Coordinated nursing care on unit through staff assignments, assisting and rounding with physicians, monitoring patient orders, and communicating with ancillary departments.
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Supervised and managed daily scheduling, tasking, and administration.
Staff Nurse LPN
Vanderbilt Hospital
Nashville, Tn
06.2018 - 01.2020
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Performed prior authorization review of services requiring notification.
- Improved patient care quality by conducting thorough utilization reviews and making recommendations for optimal treatment plans.
- Assisted discharge planning efforts through prompt identification of medically stable patients who were ready for transition to alternate levels of care.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Collaborated with physicians to clarify treatment plans, ensuring alignment with evidence-based practices.
- ICD 9 and ICD 10 codes with CMS regulations
- Pediatric and OB chart review for protection complications in development.
- Utilized time management skills to prioritize tasks effectively, allowing for efficient completion of daily responsibilities.
- Assisted with admissions, appointments, transfers, and discharges.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Ability to determine Medicare and Medicaid claim process and the rules and regulations.
Staff Nurse LPN
Franklin Hospital
Benton, Illinois
10.2017 - 01.2018
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Performed prior authorization review of services requiring notification.
- Collaborated with insurance companies to verify coverage, clarify benefits, and facilitate authorization for medical services, reducing delays in patient care delivery.
- Maintained accurate documentation of all relevant clinical data, ensuring compliance with regulatory standards.
- Assisted with admissions, appointments, transfers, and discharges.
- Improved patient outcomes by providing high-quality nursing care and closely monitoring vital signs.
- Participated in ongoing professional development opportunities to enhance knowledge base and skillset as an LPN.
Staff Nurse LPN
SIU Family Practice
Carbondale, Illinois
09.2011 - 06.2016
- Worked with all ages of people including geriatrics, took stitches out, helped with pap smears, cleaned for procedures, set up for them, and straight cath, drew labs
- Have strong knowledge of Medicare and Medicaid regulations
- Have done leadership for many years
- CMS Programs, Audits, Case Management, and Utilization Review
- Conducted regular audits of pre-authorization documentation to ensure compliance with regulatory standards and mitigate potential risks.
- Reduced denials and appeals by ensuring accurate documentation and timely submission of authorization requests.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Improved patient care quality by conducting thorough utilization reviews and making recommendations for optimal treatment plans.
- Chart review on Pediatrics and OB for potential risk in the growth and development.
- ICD 9 and ICD 10 codes
Surgical Nurse
Neuromuscular Orthopedic Institute
Mt Vernon, Illinois
11.2006 - 09.2011
- Helped with numerous physicians
- Educated patients on proper post-operative care routines, reducing the likelihood of complications or readmissions.
- Maintained accurate documentation of surgical procedures, promoting clear communication among healthcare providers regarding patient progress.
- Scheduled patients for different procedures AND called for the authorization for these procedures
- Worked with all ages of people including geriatrics, took stitches out, helped with pap smears, cleaned for procedures, set up for them, and straight cath, drew labs
- Have strong knowledge of Medicare and Medicaid regulations
- Have done leadership for many years
- CMS Programs, Audits, Case Management, and Utilization Review
- ICD 9 and ICD 10
- Collaborated with multidisciplinary teams to develop comprehensive care plans tailored to individual patient needs following surgery.
Med/Surg CNA
Franklin Hospital
Benton, Illinois
06.2005 - 11.2005
- Served as a Certified Nursing Assistant for the med/surg floor, per diem while going to school
- Performed all duties required, and assisted staff as needed
- Utilization review
- Repeatedly commended by patients and supervisors for outstanding quality of care; received consistent mention in care-survey responses
- Maintained a high degree of accuracy to achieve optimal patient acuity monitoring
- Pay: 10.00
Dialysis Technician
Nephroplex Dialysis Center
Marion, Illinois
05.2002 - 10.2004
- Provided excellent service to Renal Patients receiving dialysis
- Was integral part of team that processed and monitored patients during their treatments
- Selected to serve as Safety Control Coordinator, maintaining a safe workplace and taking preventive measures around work areas to make them safer
- Was continually praised for exceptional patient care, and instituted a better more thorough Pedal exam for patients
- Pay: 9.50
Education
Licensed Practical Nurse -
Kaskaskia College
Centralia, Illinois03.2006
Skills
- Care plan
- Procedures
- Scheduled surgery
- Attention to detail
- Case Management
- Project management
- CMS program auditing
- Knowledge of Medicare and Medicaid process
- Utilization Review and Management
- Case reviews
- Audit preparation
- Documentation and reporting
- InterQual criteria
- Records analysis
- Healthcare regulations
- Milliman guidelines
- Compliance procedures
Educationalbackground
Licensed Practical Nurse, 03/2006, Kaskaskia College, Centralia, IL, Compact Nursing Licensed, American Heart Association Health Provider CPR and AED, Venipuncture & Intravenous Therapy Certification, A.H.A. Advanced Cardiac Life Support
Professionalreferences
- Julie Douglas PA-C, 618-559-6683
- Dr. Kumar, 312-607-5955
- Dr. Kang Smith, 510-209-4168
- Barb Froehling RN, 618-214-4739
- Sara Jennings, 618-713-0358
Qualifications Summary
- Dedicated and patient-focused Licensed Practical Nurse with 30 yrs experience and compact license.
- Exceptional capacity to multi-task: manage numerous, often competing priorities with ease and foster the provision of superior patient care.
- Administrative and referral experience including admissions, assessment, treatment, referral, and education for a wide range of patients.
- Widely recognized as an excellent care provider and patient advocate.
- Outstanding interpersonal and communication skills; superior accuracy in patient history, charting, and other documentation.
- Exceptional experience in an Orthopedic Office setting, with special emphasis in surgical assists.
- Knowledge of Medicare Advantage, Original Medicare, and Medicaid appeals regulations.
- Ability to determine Medicare claim process and the rules. Have worked with ICD9 and ICD10.
- Able to prioritize my workflow consistently. Able to apply HIPAA and CMS guidelines. Always meet all my turnaround times.
- In process of getting my Utilization Review Cert.
- Committed to delivering compassionate, evidence-based care, with a focus on patient education, advocacy. and well-being.
- Extensive experience in medical necessity reviews, case management, payer collaboration to optimize resources use and ensure compliance with healthcare guidelines.
- Extensive experience in finding potential problems in growth and development OB and Pediatric charts
Timeline
Nurse
Shift Key
02.2021 - 01.2024
Charge Nurse LPN
Tradition of Brentwood
09.2020 - 02.2021
Staff Nurse LPN
Vanderbilt Hospital
06.2018 - 01.2020
Staff Nurse LPN
Franklin Hospital
10.2017 - 01.2018
Staff Nurse LPN
SIU Family Practice
09.2011 - 06.2016
Surgical Nurse
Neuromuscular Orthopedic Institute
11.2006 - 09.2011
Med/Surg CNA
Franklin Hospital
06.2005 - 11.2005
Dialysis Technician
Nephroplex Dialysis Center
05.2002 - 10.2004
Licensed Practical Nurse -
Kaskaskia College