Execution of comprehensive utilization review strategies across a 5-facilityhealthcare system, overseeing a team of 85+ utilization review and denialsprofessionals. Successfully merged 5 clinical utilization review teams into onecentralized department under the revenue cycle management. ● Created further revenue cycle synergies when leadership added theclinical denials and appeal team to my purview● Collaborate with C-Suite and senior leadership to align revenue cyclegoals with the organization's mission, resulting in improved patientcare quality and resource allocation● Design and implement standardized utilization review processescreating workflow and employee efficiencies focused on an increase incompliance with regulatory guidelines and revenue● Utilize data analytics and reporting tools to monitor key performanceindicators and utilization patterns, driving data-driven decision-making for processenhancement● Foster strong interdepartmental relationships by collaborating withclinical departments, case management, and revenue cycle teams,resulting in streamlined communication and coordination of patient care plans● Achieve improvement in overall team performance throughmentorship, training, and performance evaluation initiatives● Present utilization review strategies and outcomes to executiveleadership, contributing to informed decision-making and strategicplanning.

Highly experienced in all aspects of Case Management processes, procedures, andworkflows. Led a team of over 40+ UR Nurses and CMAs to ensure accuratepatient care while achieving optimal financial returns.● Active participant in multiple Case Management, IHS, and Financemeetings including - High Dollar, Denials management, VIP Projects,Centralized Scheduling, UM committee, CFB, MCG, andContracts/JOCs● Conduct performance reviews, oversee scheduling and payroll,perform audits, set up training, and monitor analytics● Provide strategic direction and oversight of day-to-day operationsincluding LOS management, denials management, and optimizingreimbursement while maximizing the patient's provider benefits● Work closely with Physician Advisors to develop and implementsystem-wide education programs for the UR teams, including biweeklyBoot camps, developing training materials, and orientation/onboarding● Process Improvement Projects include: Lipos/Wintex, HysterectomyCoding, Medicare IP Only list, NICU level of care, andstandardization/centralization of work documents and workflows● Concrete understanding of state and federal regulatory requirementsaffecting care coordination services specifically, CMS, HIPAA, and PHI.● Developed comprehensive staff training programs to enhanceemployees'' understanding of utilization review principles andpractices.

• Use of Milliman Care Guidelines to review patient admissions • Ability to work as a team member with exceptional communication skills• Admission, continued stay, final authorization and denials management experience• Strong analytical skills, works well under deadlines and time constraints• Extensive knowledge of medical terminology and admission assessment criteria • Interview, orienting, and mentoring of all utilization review new staff members• Works closely with Physician Advisor to monitor physician documentation and patient LOS• Proficient in Word, Excel, and utilization review modules in information systems• Concrete understanding of state and federal regulatory requirements affecting care coordination services, specifically CMS, Medicare, and HIPAA

• Provided quality pre-operative and post-operative pediatric care• Conducted patient assessment, planning, implementing, evaluating and documenting all aspects of patient care. • Coordinated and performed preoperative consults• Health history research and medical surgery clearance • Participated in sedated procedures and IV infusion therapy for pediatric patients• Trainer-Cerner Medical Documentation Program 2011-Present• Magnet-Unit Chairperson 2010-2012• ACLS, PALS, PEARS, NPR, and S.T.A.B.L.E certified

• Antepartum, Labor and Delivery, Postpartum, and Newborn Nursery RN• Direct patient care and management of high-risk clients at various stages of the birth process.• Circulated and assisted in Perinatal Operating Room• Appointed Team Leader (2004-2007) • Resource Nurse for orientation and development of new staff members • Watchchild Computer Fetal Monitoring Surveillance Trainer 2003-2007• Policy and Procedure Committee Chairperson 2005-2007• Performance Improvement Committee Member 2003-2007• Diabetic Resource Nurse

• Antenatal Testing• Fetal Monitoring• Assists Perinatologist with high-risk assessments • Assisted with amniocentesis• Assisted with chorionic villi sampling• Obtain medical and genetic patient histories • Diabetic Counseling, Teaching, and Monitoring of pregnant diabetic patients