CWCheryl Williams
@cherylwilliams
Experienced Registered Nurse with a focus on utilization review.
United StatesWhat I'm looking for
With over 25 years of experience as a Registered Nurse, I have developed a robust skill set in diverse clinical settings, including direct patient care, utilization review, and case management. My journey has been marked by a proven track record in patient assessment, care coordination, and clinical documentation review. I excel in applying medical necessity criteria and collaborating with multidisciplinary teams to ensure optimal patient outcomes.
Throughout my career, I have demonstrated strong analytical skills and attention to detail, particularly in my recent role as a Patient Care Coordinator at CareSource. Here, I conducted utilization reviews and prior authorizations for elective surgeries, utilizing Milliman Care Guidelines to determine medical necessity. My ability to manage high-volume caseloads independently, while maintaining compliance with regulatory standards, has been a key factor in my success.
I am now looking to transition my extensive nursing experience and proficiency in healthcare technology to a dedicated utilization review role. I am passionate about leveraging my clinical expertise to enhance patient care and ensure efficient healthcare delivery.
Experience
Work history, roles, and key accomplishments
Inpatient Nurse
Ohio Valley Surgical Hospital
Aug 2020 - Present (4 years 11 months)
Delivered comprehensive nursing care for surgical and orthopedic patients, ensuring compliance with documentation standards. Assessed and prioritized care for post-operative patients, consistently meeting discharge timeline goals and collaborating with interdisciplinary teams through EHR communication.
Staff Nurse
Forest Glen Health Campus
Apr 2020 - Aug 2020 (4 months)
Managed daily care for long-term residents, specializing in geriatric and memory care populations. Performed comprehensive assessments and documented care plans in the facility's EHR system, coordinating with physicians and families.
Staff Nurse
Madison Health
Nov 2017 - Apr 2020 (2 years 5 months)
Delivered comprehensive nursing care for medical, surgical, and orthopedic patients, maintaining compliance with documentation standards. Performed comprehensive assessments and documented wound care treatment plans in the facility's EHR system, ensuring continuity of care.
Patient Care Coordinator / Utilization Management
CareSource
Jan 2016 - Oct 2017 (1 year 9 months)
Conducted utilization reviews and prior authorizations for elective surgeries using Milliman Care Guidelines (MCG) criteria. Analyzed medical documentation daily to determine medical necessity, collaborating with physicians and clinical staff for coverage determinations.
Education
Degrees, certifications, and relevant coursework
Community Hospital School of Nursing
RN Diploma, Nursing
Completed a comprehensive diploma program in nursing. Gained foundational knowledge and practical skills necessary for a career as a Registered Nurse.
Tech stack
Software and tools used professionally
Availability
Location
United StatesAuthorized to work in
Job categories
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