Carrie Best
Winfield
Summary
Dynamic nursing professional with extensive experience at Centene Corporation, specializing in discharge planning and patient advocacy. Demonstrated leadership in managing complex patient conditions while ensuring regulatory compliance. Proficient in clinical documentation and critical thinking, contributing to high standards of patient-centered care and effective case management strategies.
Overview
1
1
Certification
11
11
years of professional experience
Work History
Concurrent Review Nurse
Centene Corporation
03.2024 - Current
- Review daily clinical updates, diagnostic results, consult notes, and orders to determine whether ongoing hospitalization meets medical necessity criteria.
- Evaluate appropriateness of admission, ongoing inpatient days, and transitions to SNF, rehab, LTACH, or home care
- Collaborated with physicians and hospital care teams to ensure alignment on patient care and treatment plans
- Managed and escalated complex patient cases to appropriate specialists for further evaluation.
- Monitored and ensured adherence to regulatory standards in clinical practices.
- Assisted in coordinating patient care among multidisciplinary teams to enhance service delivery.
Prior Authorization Nurse
Centene Corporation
08.2020 - 03.2024
- Ensure treatments meet medical necessity standards
- Ensured treatments met medical necessity standards to facilitate appropriate patient care
- Supported accurate claims processing to minimize delays and maximize reimbursement
- Reviewed patient records for accuracy and completeness
- Communicated effectively with healthcare providers to gather necessary information
- Assisted case managers in coordinating patient care and services
- Made informed coverage determinations based on medical guidelines
Director of Nursing
Lincoln County Nursing and Rehab
Troy
07.2019 - 07.2020
- Supervised and reviewed nursing staff to ensure compliance with care standards
- Oversaw department budgets to align resources with patient care needs
- Overseeing the department budgets
- Interacting with doctors, patients and family members
- Organized patient data and medical records efficiently
- Reporting to high-level staff members
Charge Nurse, Clinical Coordinator, Staff Nurse
DaVita Dialysis Clinic
Saint Peters
10.2016 - 07.2019
- Supervised nursing staff, ensuring compliance with patient care standards to enhance quality of care.
- Monitored patient vital signs and reported changes directly to physicians.
- Coordinated patient treatment schedules and managed medication administration.
- Provided direct patient care, including assessments and treatments for diverse patients.
- Facilitated communication between patients' families and healthcare teams, improving patient understanding and satisfaction.
- Developed educational materials on dialysis procedures and home care, aiding in patient education and self-management.
- Developed educational materials on dialysis procedures and home care.
Registered Nurse, BSN
St. Louis University Hospital
St. Louis
05.2015 - 04.2015
- Charge Nurse on a 23-bed Intermediate Cardiology Unit and Cardiothoracic Surgical Unit
- Led charge nurse responsibilities on 23-bed intermediate cardiology and cardiothoracic surgical units
- Coordinated discharge planning for patients, ensuring all necessary arrangements were made for a smooth transition home.
- Managed chest tube insertion and maintenance procedures in patient care settings.
- Interpreted patient telemetry strips to monitor and respond to patient conditions
- Coordinated with health care team to assess, plan, implement, and evaluate patient care plans
- Performed medical documentation requirements
Education
Bachelors of Science - Nursing
University of Missouri St. Louis
St. Louis, MO04-2015
Skills
- Patient discharge planning
- Medical record analysis
- Collaborative teamwork
- Risk assessment
- Complication recognition
- Acute care knowledge
- Medical charting accuracy
- Medical terminology
- Complex condition management
- Accurate medical charting
- Complex case evaluation
- Medical terminology proficiency
- Medicaid knowledge
- Patient advocacy
- Utilization review
- Catastrophic care management
Certification
- Registered Nurse (RN), 10/01/07 to 04/01/27
- Infection Preventionist
Timeline
Concurrent Review Nurse
Centene Corporation
03.2024 - Current
Prior Authorization Nurse
Centene Corporation
08.2020 - 03.2024
Director of Nursing
Lincoln County Nursing and Rehab
07.2019 - 07.2020
Charge Nurse, Clinical Coordinator, Staff Nurse
DaVita Dialysis Clinic
10.2016 - 07.2019
Registered Nurse, BSN
St. Louis University Hospital
05.2015 - 04.2015
Bachelors of Science - Nursing
University of Missouri St. Louis