Candice Bivens
Location
Tuscaloosa, AL
Education
T
The University of Alabama
August 2002 - December 2006
degree
Bachelor's
major
Nursing
Work Experience
V
Viva Health
Utilization Review/Case Manager
Birmingham, AL, US
April 2023 - April 2024
company
Viva Health
title
Utilization Review/Case Manager
overview
- Processes prior authorization and retrospective requests, by evaluating the medical necessity of requests submitted by providers
- Responsible for ensuring that authorization requests, provider and member clinical inquiries are processed timely accordingly to CMS
- Collaborates with facility staff, member's PCP, Plan Medical
- Directors, facility-based Nurse Practitioners, Care Management staff, and others regarding management of members not meeting
- Identifies opportunities for process and policy improvement
B
Brookwood Baptist Medical Center
RN
Birmingham, AL, US
July 2022 - July 2023
M
Mary Harper Center
RN
Tuscaloosa, AL, US
October 2021 - June 2022
T
Tuscaloosa VA Medical Center
RN
July 2021 - October 2021
N
North Harbor
RN
Tuscaloosa, AL, US
January 2021 - June 2021
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Skills
CardiologyCare StandardsCernerClinical PracticesClinical WorksCommunication SkillsCompetency-Based DevelopmentComplex CareConflict ResolutionContent ManagementCoordination SkillsCritical ThinkingCustomer ServiceData CollectionDecision Making SkillsDelivery of ProjectsDisease ManagementEvidence-Based PracticeGeriatricsHealth AdministrationHealth AssessmentHealth CareHypertensionICD-10 Medical ClassificationIntramuscular InjectionKnowledge of ElectrocardiographyKnowledge of MedicineLeadershipLicensed Practical NurseLife SupportManaged CareMedical Necessity DoctrineMedical RecordsMedicationsMeditechMental HealthMentoringNurse EducationNursingOracle ApplicationsPatient AssessmentPerseverancePulmonologyRehabilitationsSafety PrinciplesSelf MotivationService IndustriesSimulationsSurgical ProceduresTeam ManagementTeam WorkingTelemetryTesting SkillsUtilization ManagementVentilation FansWound Care