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Skills

  • Patient-centered care advocacy
  • Preventative health
  • Well visit procedures
  • Negotiation with third-party payers
  • Medical necessity criteria assessments
  • Home care
  • Denial management and appeal strategies
  • Medication administration
  • Health education and preventive care guidance
  • Case management

Work Experiences

  • Gave medications and treatments to patients and tracked their responses while collaborating with healthcare teams to adjust treatment plans.
  • Observed and reported on the patient's condition, progress, and medication side effects to accurately document updates.
  • Physical assessments, medication, and chronic disease management were all part of my care for home health patients.
  • Medication and IV administration, catheter insertion, and airway management were among the interventions I implemented.
  • Assisted in creating a quarterly performance review dashboard, streamlining tracking of key utilization metrics for performance improvement.
  • Oversaw nursing activities for 6 departments at a 2-bed hospital with 2+ employees, advising nurses on how to provide excellent patient care and satisfaction.
  • Achieved recovery through documentation correction.
  • Advocated for patient access to necessary services.
  • Adhered to regulatory compliance.
  • Conducted ongoing assessments to assess mental health needs and collaborated with a multidisciplinary team to create, implement, manage, and modify individualized care plans.

Summaries

  • Accomplished in discharge planning optimization and reducing average inpatient stay from 16 to 17 days, resulting in significant cost savings and improved patient throughput.
  • Costs were consistently reduced while profits were increased.
  • Achieved results within three years.
  • Achieved a 49% improvement in alternate level-of-care transitions.
  • Successfully led unit-based groups to improve care delivery and patient satisfaction.
  • Collaborative Utilization Nurse known for establishing multidisciplinary workflows that enhance communication and reduce case resolution timeframes by 43%.
  • Registered Nurse, North Carolina Board-Certified, with 8 years of experience providing high-quality care to patients in program and initiative care units.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Achieved significant cost savings.
  • Proven leader with a track record of successfully uniting and guiding nursing teams toward patient care goals, increased satisfaction, and the continuous implementation of widespread healthcare system initiatives.

Accomplishments

  • Resolved product issue through consumer testing.
  • Trained new utilization nurses on the proper application of Lean criteria, improving adherence by 63% after 4 months implementation.
  • Monitored and optimized care pathways, reducing unnecessary inpatient admissions by 83% without compromising patient outcomes.
  • Collaborated with interdisciplinary teams to design and implement post-acute care transition pathways, reducing readmission rates by 76% over 6 months.
  • Developed guidebooks for utilization nurse staff, standardizing care assessments and consistency in the application of Salesforce tools.
  • Collaborated with care coordination teams to reduce unjustified denials by 32% through enhanced clinical documentation.
  • Designed and delivered educational modules on utilization review, resulting in a 36% improvement in physician documentation practices.
  • Reduced the rate of clinical escalations by 45% through proactive care management and patient discharge coordination.
  • Partnered with leadership to roll out care utilization strategies that aligned with organizational cost-saving goals, reducing overall patient care costs by $117,000.
  • Implemented a robust case review process that led to the early identification of medical necessity issues, increasing approval rates by 44%.

Affiliations

  • National Association of Healthcare Revenue Integrity (NAHRI)
  • Association of Information Technology Professionals
  • Academy of Managed Care Pharmacy (AMCP)
  • National Association of Independent Review Organizations (NAIRO)
  • Association for Supply Chain Management (APICS)
  • Society of Human Resource Management
  • Rotary International
  • Healthcare Financial Management Association (HFMA)
  • Healthcare Auditing and Resource Monitoring Association (HARMA)
  • Transformational Healthcare Leadership Council (THLC)

Certifications

  • Six Sigma Green Belt for Healthcare (SSGB-HC)
  • Lean Six Sigma Black Belt Certification - Healthcare Focus
  • Microsoft Certified Systems Engineer (MCSE)
  • Advanced Care Transition Coordination Certification (ACTCC)
  • First Aid/CPR Certified
  • Cisco Certified Network Associate (CCNA)
  • Certified Healthcare Access Manager (CHAM)
  • Certified Diabetic Educator (CDE)
  • Certified Public Accountant
  • Certified Rehabilitation Registered Nurse (CRRN)

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