Summary
Overview
Work History
Education
Skills
Timeline
Generic

JESSICA GULLEY

Fuquay-Varina

Summary

Highly experienced Registered Nurse with 12+ years in acute care and telehealth, specializing in utilization management, triage, and prior authorization. Seeking a remote position to leverage expertise in virtual care and improve patient outcomes.

Overview

11
11
years of professional experience

Work History

Care Advisor/Triage Nurse

Carenet Healthcare
08.2023 - Current
  • Performed triage assessments for over 50 patients daily in a busy telehealth environment.
  • Designed and launched triage protocols, achieving a 30% reduction in ER and UR visits over six months.
  • Delivered telephone support to 100+ patients, enhancing understanding of medication compliance and health management.
  • Resolved 100+ patient queries weekly, recommending tailored treatments that aligned with insurance benefits, enhancing patient satisfaction.
  • Telecommute

Utilization Review Nurse

United Healthcare
04.2019 - Current
  • Conducted comprehensive reviews of medical necessity for inpatient admission and continued stays.
  • Collaborated with multidisciplinary teams to ensure optimal patient care and resource utilization.
  • Developed and implemented clinical guidelines utilizing InterQual and MCG review processes and improve efficiency.
  • Analyzed clinical data to identify trends, ensuring adherence to regulatory standards and protocols.

Preservice Review/Prior Authorization RN

United Healthcare
04.2019 - Current
  • Evaluated documentation for the medical appropriateness of over 30 services, enhancing patient care and improving approval rates by 15%.
  • Utilized evidence-based guidelines for Medicaid, Medicare, and IFP to make informed decisions regarding approving and denying 100+ requested services.
  • Facilitated communication with 20+ insurance representatives, resulting in a 20% increase in treatment approvals by providing alternatives.
  • Collaborated with 60+ healthcare providers and patients to ensure 97% accurate processing of prior authorization request.
  • Telecommute

Pediatric Triage Nurse

Triage4Pediatrics
04.2020 - 08.2023
  • Implemented the Barton/Schmidt protocol, enhancing process efficiency by 25% and reducing errors by 15%.
  • Implemented targeted outreach programs, educating over 200 pediatric patients, resulting in a 30% increase in care compliance.
  • Achieved 30% faster project completion by optimizing time management strategies and prioritizing tasks effectively.
  • Telecommute

Hemodialysis Nurse

Fresenius Medical Care
04.2017 - 08.2020
  • Administered hemodialysis treatment to over 50 patients with chronic and acute renal failure, improving patient outcomes by 20%.
  • Monitored and evaluated patient responses to treatments and applied appropriate adjustments.

Medical/Surgical Travel Nurse

Supplemental Health Care Travel Agency
09.2014 - 04.2019
  • Managed care for 15+ patients daily by administering medications, initiating IV fluids, and meticulously documenting intake/output.
  • Successfully completed 13-week contracts at 5 hospitals across NC, SC, and VA, enhancing patient care for over 300 individuals.

Education

Bachelor of Science - Nursing

Winston Salem State University
Winston Salem, NC
05.2019

Associates of Applied Science - Nursing

Guilford Tech Community College
Jamestown, NC
05.2013

Bachelor of Art - Biology

University of North Carolina at Greensboro
Greensboro, NC
05.2009

Skills

  • Current unrestricted Compact State RN license, California License, DC License, RI License, NM License
  • 7 years of RN clinical experience in multiple hospital inpatient/acute and chronic care settings
  • 12 years as a Registered Nurse (RN)
  • Exemplary clinical documentation skills utilizing Milliman, InterQual, ICUE HSR, ETS, Doc360, ECQA, EPIC
  • Experience in medical necessity review, medical record review, medical record audits, appeals/grievances, LTSS, prior authorization/preservice review, inpatient case management, appeals/denials, Nurse Triage, Usage of Barton/Schmidt Protocol
  • Experience in HCPCS, ICD 10 and CPT coding

Timeline

Care Advisor/Triage Nurse

Carenet Healthcare
08.2023 - Current

Pediatric Triage Nurse

Triage4Pediatrics
04.2020 - 08.2023

Utilization Review Nurse

United Healthcare
04.2019 - Current

Preservice Review/Prior Authorization RN

United Healthcare
04.2019 - Current

Hemodialysis Nurse

Fresenius Medical Care
04.2017 - 08.2020

Medical/Surgical Travel Nurse

Supplemental Health Care Travel Agency
09.2014 - 04.2019

Associates of Applied Science - Nursing

Guilford Tech Community College

Bachelor of Art - Biology

University of North Carolina at Greensboro

Bachelor of Science - Nursing

Winston Salem State University

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JESSICA GULLEY