Ronald Harris
Utilization Review RN
- Role
- Utilization Review Nurse at Providence Health Plan
- Location
- Portland, OR, US
- LinkedIn followers
- 500 followers
About Ronald Harris
Selected Achievements • Continued my MSN during COVID while working and finishing the program before I was 30-years old.• Told a patient that I graduated from MSU and stated, “I have a Spartan as a nurse.”• Mentored and supported nursing students and new nurses of color while continuing my nursing journey. Utilization Management Nurse Consultant I MSN-Nursing Informatics• Utilization Management (UM) Nurse Consultant with Master of Nursing Informatics (MSN) and 2+ years of utilization management experience. 5+ years of clinical nursing experience, including patient education and health literacy. Strong telephonic, analytical, and documentation skills. Current, unrestricted Registered Nurse (RN) License in Oregon.
Experience
Utilization Review Nurse
May 2023 — Present · Beaverton, OR, US
Applied advanced nursing assessment and care planning expertise to conduct utilization reviews, ensuring safe, evidence based care.• Evaluated medical necessity and coordinated case management referrals, improving care transitions and reducing delays.• Initiated case management referrals for high-risk members, improving care transitions and reducing delays.• Leveraged analytical skills to review complex medical records, clearly communicating determinations to providers and payers.• Maintained compliance with CMS regulations, updating internal resources and guiding colleagues on policy changes.• Cross trained in claims payment review, collaborating with coding analysts and physicians to resolve complex cases.• Supported members through benefit navigation and appeals, helping patients access in network options with empathy and clarity.• Evaluated medical necessity for Oregon Health Plan (OHP) and commercial plans using InterQual, CMS, and OAR criteria improving consistency and defensibility of determinations.
Education
Capella University
Master of Nursing , Nursing Informatics
Michigan State University
Bachelor’s Degree, Nursing
2011 — 2016
Skills
- Community Outreach
- Microsoft Office
- Public Speaking
- Event Planning
- Powerpoint
- Social Networking
- Critical Thinking
- Fundraising
- Healthcare
- Research
- Leadership
- Social Media
- Microsoft Powerpoint
- Microsoft Word
- Team Leadership
- Time Management
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