Karen Hayes
New Johnsonville
Summary
BSN-prepared Registered Nurse with 14+ years of nursing experience with a solid foundation in patient care and medical management. Proven ability to handle complex medical scenarios and collaborate effectively with healthcare teams to optimize patient outcomes. Known for reliability and adaptability, consistently meeting changing needs of patients and healthcare environments. Skilled in patient assessment, care planning, and medication administration, with strong commitment to compassionate care. Currently enrolled in a Master of Science in Nursing-Family Nurse Practitioner program, further strengthening advanced clinical knowledge and evidence-based practice skills.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Long-Term Care RN
Signature Healthcare
Erin, TN
08.2025 - Current
- Coordinate post-hospital services including skilled nursing, home health, and community-based resources.
- Provide compassionate care to long term and skilled nursing residents.
- Administer medication and treatments in compliance with care plans and regulatory standards.
- Monitor patient vital signs and reported significant changes to the healthcare team promptly.
- Advocate for residents' needs, ensuring dignity and respect in all aspects of care delivery.
- Develop trusting relationships with residents and families by exhibiting empathy, active listening skills, and professionalism in all interactions.
Clinic Nurse (PRN)
Fast Pace Urgent Care
Waverly, TN
10.2023 - Current
- Completed patient assessments, vital signs, and medical history documentation.
- Oversaw triage processes to prioritize patient care based on urgency and clinical need.
- Collaborated with multidisciplinary teams to develop and implement individualized treatment plans for diverse patient populations.
- Administered medications accurately as prescribed by physicians while monitoring for adverse reactions or interactions among multiple prescriptions.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
Utilization Review RN Manager – Prebill Denials
Parallon Healthcare
Nashville, TN
06.2024 - 08.2025
- Lead team of 15 RNs and denial analysts in utilization review and insurance compliance processes.
- Analyzed denial trends and implement workflow improvements to reduce delays in care and reimbursement.
- Ensured compliance with Medicare, Medicaid, and Commercial payer guidelines.
- Conducted regular performance evaluations, fostering a culture of accountability and continuous improvement among team members.
- Prioritized and distributed assignments and workload based on individual staff strengths and experience.
- Led staff meetings to keep team informed of departmental changes and provide opportunities for nurses to share ideas and concerns.
- Developed and implemented training programs for staff development and compliance with healthcare regulations.
Utilization Review RN Team Lead – Prebill Denials
Parallon Healthcare
Nashville, TN
01.2023 - 06.2024
- Collaborated with hospital case management and discharge teams across 80+ facilities.
- Led education initiatives to improve case management workflows and productivity.
- Mentored new hire employees, fostering a collaborative environment and enhancing professional development.
- Contributed to a positive work culture by recognizing individual achievements among staff members and promoting ongoing professional development opportunities.
- Elevated teamwork among staff members through open communication channels, fostering a collaborative work environment conducive to problem-solving and continuous learning.
Utilization Review RN – Prebill Denials
Parallon Healthcare
Nashville, TN
09.2019 - 01.2023
- Conducted thorough reviews of patient medical records to evaluate the appropriateness, medical necessity, and efficiency of healthcare services and treatments.
- Evaluated medical necessity and appropriateness of care for patient treatment plans.
- Collaborated with healthcare teams to ensure compliance with utilization management standards.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
Critical Care Float Nurse
Tristar Horizon Medical Center
Dickson, TN
11.2012 - 03.2018
- Administered critical care interventions in high-pressure environments across multiple departments.
- Monitored vital signs and responded promptly to changes in patient conditions.
- Collaborated closely with physicians to evaluate patient progress and adjust treatment plans as needed to achieve optimal outcomes.
- Served as a preceptor for new graduate nurses, fostering professional growth within the nursing workforce.
Education
Master of Science in Nursing - Family Nurse Practitioner
Austin Peay State University
Clarksville, TN05-2028
Bachelor of Science in Nursing - Nursing
Western Governors University
Salt Lake City, UT04-2017
Associate of Applied Science in Nursing - Nursing
Jackson State Community College
Jackson05-2012
Skills
- InterQual Reviews
- Medical Necessity Determination
- EMR & Advanced Computer Proficiency
- Case Management & Utilization Review
- Treatment administration
- Multitasking
- Compassionate and caring
- Strong clinical judgment
- Adaptability and flexibility
- Analytical thinking
- Critical care nursing
- Vitals monitoring
Certification
- Registered Nurse TN Compact License # 188176
- American Heart Association Basic Life Support 09/25-09/27
- Model-Netics Leadership Certification 09/2025
Timeline
Long-Term Care RN
Signature Healthcare
08.2025 - Current
Utilization Review RN Manager – Prebill Denials
Parallon Healthcare
06.2024 - 08.2025
Clinic Nurse (PRN)
Fast Pace Urgent Care
10.2023 - Current
Utilization Review RN Team Lead – Prebill Denials
Parallon Healthcare
01.2023 - 06.2024
Utilization Review RN – Prebill Denials
Parallon Healthcare
09.2019 - 01.2023
Critical Care Float Nurse
Tristar Horizon Medical Center
11.2012 - 03.2018
Master of Science in Nursing - Family Nurse Practitioner
Austin Peay State University
Bachelor of Science in Nursing - Nursing
Western Governors University
Associate of Applied Science in Nursing - Nursing
Jackson State Community College