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Skills

  • Healthcare performance metrics
  • Drug utilization review
  • Budget oversight for high-cost cases
  • Multi-site health system management
  • KPI dashboard development
  • Staff management
  • Policy development and enforcement
  • Healthcare cost containment strategies
  • Healthy meal preparation
  • Healthcare quality improvement

Work Experiences

  • Analyzed patient flow data.
  • Brainstormed and implemented hard stops.
  • Coached and mentored a team of 13 utilization review nurses.
  • Accomplished results within 2024.
  • Was in charge of ordering all pharmacy supplies and keeping track of inventory levels.
  • Created and updated HIPAA, benefits administration, and general liability policies and procedures while adhering to statutory, regulatory, and local, state, and federal guidelines.
  • Achieved favorable reimbursement structures totaling 17.
  • Achieved a strategic increase of 20% in productivity.
  • Appointed as the regional leader for utilization integrity, implementing regional guidelines that reduced claim denials across 15 facilities.
  • Collaborated with compliance to review outlier cases, resulting in a 2 clawback from insurance denials.

Summaries

  • Accomplished healthcare professional.
  • Boosted nurse efficiency and morale.
  • Entry-level Pharmacy Manager with exceptional process improvement and workflow optimization knowledge.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Achieved improvements in overall department efficiency by 58%.
  • Healthcare administrator with a track record of providing high-quality healthcare services to patients.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Staff development that results in high-performing teams has been recognized.
  • Professional with experience in recruiting, training, and managing employees to provide exceptional resident services in the healthcare industry.
  • Oversee human resources, budgeting, supply management, and patient services with success.

Accomplishments

  • Provided strategic input during accreditation surveys by category, leading to an award of compliance distinction in UR processes across 2019.
  • Designed discharge planning protocols that streamlined post-acute transfer processes, achieving a 79% reduction in delays.
  • Reduced average length of stay by 28% days through improved patient flow and clinical documentation training for physicians.
  • Developed utilization management educational modules for providers, resulting in 83% better adherence to payer guidelines across 2 specialties.
  • Implemented a regional utilization review model leading to a 75% reduction in hospital readmission across 8 facilities.
  • Led a team of 9 utilization review nurses, improving denial overturn rates by 64% over the course of 2022.
  • Developed and implemented new workflows in the Utilization Review (UR) department that shortened provider review turnaround times by 64% hours.
  • Directed a system-wide internal audit initiative to assess utilization review team compliance, improving adherence to payer guidelines by 55% within 15 months.
  • Successfully reduced claim rejection rates for high-cost specialty drugs by 79% by implementing a regimented pre-authorization system.
  • Created a UR-specific decision-support tool that resulted in 42% faster prior authorization reviews, decreasing processing delays and improving patient flow.

Affiliations

  • National Association of Healthcare Revenue Integrity (NAHRI)
  • Society of Hospital Medicine (SHM)
  • Association for Supply Chain Management (APICS)
  • Society of Women Engineers
  • Freemason
  • Jaycees
  • Institute for Healthcare Improvement (IHI)
  • Healthcare Leadership Network of the North Carolina
  • Toastmasters
  • Council for Affordable Quality Healthcare (CAQH)

Certifications

  • Health Services Administration Certificate - 2015
  • Certified Utilization Review Specialist (C-URS) - 2016
  • Google Certified Professional Cloud Architect
  • Registered Health Information Administrator (RHIA) - 2017
  • ServSafe
  • Certified Professional in Healthcare Quality (CPHQ)
  • SHRM Senior Certified Professional (SHRM-SCP)
  • CompTIA A+ Technician
  • Certified Executive in Healthcare Information Management (CEHIM) - 2020
  • Certified Specialist in Managed Care (CSMC)

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