Adriane Stevens
Portsmouth,VA
Summary
Results-driven Utilization Review Manager with expertise in HIPAA compliance, healthcare regulations, and process improvement. Proven track record of enhancing clinical review operations, ensuring adherence to regulatory standards, and leading high-performing teams.
Overview
19
19
years of professional experience
Work History
Utilization Review Manager
Elevance Health
Norfolk, VA
10.2015 - 04.2026
- Oversaw utilization review processes, ensuring compliance with regulatory requirements and internal policies.
- Developed and implemented strategic initiatives to enhance efficiency in clinical review operations.
- Led a team of nurses and analysts, providing mentorship and guidance on complex case evaluations.
- Analyzed data trends to identify areas for improvement in care management and resource allocation.
Team Leader
Elevance Health
Norfolk, VA
05.2014 - 10.2015
- Developed strategic initiatives that improved team performance and service delivery standards.
- Mentored junior staff, fostering professional growth and enhancing team capabilities.
- Implemented quality assurance protocols to ensure compliance with industry regulations.
Licensed Utilization Review Nurse
Elevance Health
Norfolk, VA
09.2013 - 05.2014
- Conducted comprehensive utilization reviews to assess medical necessity and appropriateness of services.
- Collaborated with healthcare providers to ensure compliance with clinical guidelines and regulatory standards.
- Developed and implemented process improvements to enhance review efficiency and accuracy.
Staff Nurse
DePaul Hospital
Norfolk, VA
01.2010 - 12.2013
- Administered medications and treatments according to physician orders and established protocols.
- Monitored patient vital signs, identifying changes and notifying healthcare team promptly.
- Educated patients and families on health conditions, treatment plans, and self-care techniques.
- Collaborated with interdisciplinary teams to develop and implement individualized care plans.
Office Manager
Lighthouse Outreach
Hampton, VA
12.2006 - 01.2008
- Streamlined office operations through effective scheduling and resource allocation.
- Managed team communications, enhancing collaboration and information flow.
- Implemented filing systems
- Developed training programs for new staff, fostering a knowledgeable workforce.
Education
Bachelor of Science - Nursing
South University
Virginia Beach, VAAssociate of Science - Nursing
Medical Careers Institute
Newport News, VASkills
- HIPAA compliance
- Healthcare regulations
- Utilization management
- Medical coding
- Knowledge of Facets, Compass, and ACMS
- Case review expertise
Timeline
Utilization Review Manager
Elevance Health
10.2015 - 04.2026
Team Leader
Elevance Health
05.2014 - 10.2015
Licensed Utilization Review Nurse
Elevance Health
09.2013 - 05.2014
Staff Nurse
DePaul Hospital
01.2010 - 12.2013
Office Manager
Lighthouse Outreach
12.2006 - 01.2008
Bachelor of Science - Nursing
South University
Associate of Science - Nursing
Medical Careers Institute
License
Registered Nurse #0001221849 Expires 5/31/2027