Linda Williams

I'm an 18 year highly motivated LPN Nurse with a most recent background in Utilization/Clinical Nurse Review positions with well-rounded skills within the Medicare/Medicare HMO and Third-Party Vendor companies. Providing quality reviews, care and customer service. 

I'm Committed, reliable and dependable with a 13.5-year history in the Clinical Utilization Management Department as a Clinical Coordinator, Utilization Review Nurse Sr, Precertification or Authorization Nurse Reviewer. I possess skills such as, performing expedited/regular Turnaround time Utilization reviews for medical necessity, working closely with Medical Directors on a day-to-day bases 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 que and Fax II Ques.  Provide education as needed and problem resolutions to members, providers/provider representatives. Problem resolution/solving, training and educational needs for member, providers and Clinical Review Nurse Team Leader in a Healthcare Call Center and Health Plan Environment. 5 Year background in Primary Hospital, Nursing home and Doctor’s office patient care.

AT HEALTHHELP HEALTHCARE: (Clinical Review Nurse-Phone/Fax clinical reviews).

1. Recent remote role as Licensed Utilization Review Nurse/Clinical Coordination for 1.5-years, performing expedited/regular utilization reviews for medical necessity through our 3rd party vendor working all diagnostic cases to include, (PET Scans, CT’s, MRI/MRA, Cardiac cases) working and assigning cases to the Medical Directors as needed.  Approvals sent via fax or call to providers.  Work cases via assignment tool or email for Humana, Lumeris, and several other Healthcare Organizations or via Fax II Ques. Provider education, problem resolutions.

AT AMERIGROUP/ANTHEM/SIMPLY HEALTHCARE: LPN Nurse Phone/Fax utilization reviewer. Team Lead Review GA/TN State Markets. Nurse and Processes Trainer.

1. Previously worked remotely 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 bases 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 que and Fax II Ques.  Provide education as needed and problem resolutions to members, providers/provider representatives. 
2. Maintained Team Leader/Utilization Review position 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. 
3. 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.

*ERWIN HIGH TECHNICAL CENTER – TAMPA, FL

Licensed Practical Nursing-LPN 2003-2004.

-Certified Professional in Healthcare Management, 2011.  AMERIGROUP TAMPA, FL.