Utilization Management Nurse Lead Resume Example
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UTILIZATION MANAGEMENT NURSE LEAD
Summary
I am creative and enthusiastic with progressive management skills and diverse capability range in many areas of nursing services. I have proven ability to work with physicians and other healthcare professionals to achieve quality, safety and financial and patient satisfaction.
Skills
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Experience
Erickson Living | Pompton Plains , NJUtilization Management Nurse Lead09/2018 - 10/2019
- Adheres to accreditation, contractual and regulatory time frames in performing all utilization management review processes.
- Performed initial, concurrent and retrospective review activities, discharge care coordination for determining efficiency, effectiveness and quality of medical /surgical services and servicing as liaison between providers and Medical and Network Management Divisions with the three IPA groups assigned too.
- Consulted with the Medical Director on all cases that do not meet clinical criteria
- Advocated for patients by identifying insurance coverage, communicating care preferences to practitioners and verifying interventions met patients' treatment goals.
- Utilized computerized Resource and Patient Management System Maintains accurate and timely documentation in the Electronic Health Records (EHR) and review cases using MCG (Milliman) and/or Interqual criteria.
Health Alliance Of Hudson Valley | Wallkill , NYCase Management & Transition Care Nurse01/2015 - 03/2018
- Observed strict confidentiality and safeguarded all patient-related information.
- Oversaw assigned utilization review activities and transitional care duties on a daily basis, ensuring level of care and length of stay was medically appropriate.
- Reviewed, oversaw, and intervened with discharge planning needs, ensuring coordination and continuity of health care for enrollment's as they transferred between locations or different levels of care.
- Followed up with patient family member post-discharge as part of their transition of care, aiding in member not being remitted.
- Provided leadership support to clinical staff, professional and nonprofessional teams. Accountable for day-to-day operation for clinical staff of 19-bed telemetry unit and 15-bed intensive care unit on 24-hour coverage by phone or pager
Saint Anthony Hospital | City , STATERegistered Nurse Clinical Manager03/2011 - 10/2014
- Provided leadership support to clinical staff, professional and nonprofessional teams. Accountable for day-to-day operation for clinical staff of 19-bed telemetry unit and 15-bed intensive care unit on 24-hour coverage by phone or pager.
- Successfully implemented quality improvement for core measures, decreasing agency cost due to vacancy in telemetry unit by hiring qualifying staff.
- Resolved staffing issues by recruiting and hiring top-level talent.
- Consulted with healthcare clients on nursing procedures and policies, implementing changes for improvement.
PCC Community Wellness Center | City , STATEClinical Administrator05/2008 - 05/2011
- Coordinated delivery of exceptional patient care by evaluating workflow and facilitating positive patient and physician changes for customer satisfaction.
- Provided leadership support for clinical staff.
- Provided administrative accountability to include assessment, planning, implementation, and evaluation of delivering quality patient care.
- Participated in QA & PI process, clinic's strategic plan. Developed and implemented P&P. Coordinated daily operation to ensure quality patient care. Monitored budget in a cost-effective manner.
- Resolved conflicts promptly among physicians, nurses and other healthcare employees to keep workflow on task.
- Recruited well-qualified candidates to fill vacancies and offer residents unparalleled care.
Education and Training
Spertus Institute For Jewish Learning And Leadership | City, StateMaster of Science in Human Services05/2005
Chicago State University | City, StateBachelor of Science in Nursing Science12/2001
Malcolm X College | CityAssociate of Science in Nursing Science05/1992
ADDITIONAL RELEVANT EXPERIENCE
ADVOCATE HEALTH CARE, CHICAGO, IL
Nursing Administrative, Patient Care Services/ Patient Care Coordinator/ Case Manager / Supplemental Staffing Agency
MOUNT SINAI HOSPITAL, CHICAGO, IL
Registered Staff Nurse, Staff nurse, Telemetry and ICU unit, and Utilization& Quality Management
NORWEGIAN AMERICAN HOSPITAL, CHICAGO, IL
Reviewed and revised policies and procedures. Implemented hospital wide quality including SBAR criteria for best practices in communication.
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Resume Overview
School Attended
- Spertus Institute For Jewish Learning And Leadership
- Chicago State University
- Malcolm X College
Job Titles Held:
- Utilization Management Nurse Lead
- Case Management & Transition Care Nurse
- Registered Nurse Clinical Manager
- Clinical Administrator
Degrees
- Master of Science in Human Services
Bachelor of Science in Nursing Science
Associate of Science in Nursing Science
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