Alexis Bradley

Plumas Lake,CA

Summary

Dynamic Nursing and Healthcare Professional with 19 years of comprehensive experience in clinical practice, utilization management, and nursing leadership. Proven track record of enhancing patient outcomes through the development of standardized workflows, effective training and mentoring of staff, and collaboration with multidisciplinary teams. Expertise in managing complex utilization processes and improving transitions of care while fostering strong communication and relationships as a professional liaison. Recognized for adeptness in conflict resolution, project management, and strategic planning, with a commitment to driving success through reliable partnerships and clear communication.

Overview

Certification

years of professional experience

Work History

Utilization Management Managed Care Liaison

DIGNITY HEALTH MEDICAL FOUNDATION

01.2016 - Current

Provide utilization management and managed care expertise across the continuum of care, collaborating with hospitals, health plans, skilled nursing facilities, physicians, case managers, and interdisciplinary teams.
Support utilization management activities involving 25+ skilled nursing facilities, maintaining collaborative relationships with facility leadership and clinical teams.
Perform and coordinate Managed Care prior authorizations and concurrent reviews, evaluating referral requests, clinical documentation, patient status, level of care, and medical necessity.
Apply InterQual criteria and clinical judgment to support appropriate utilization decisions and prepare relevant clinical information for physician/medical reviewer consideration.
Review clinical records and supporting documentation for completeness, accuracy, and alignment with payer and utilization management requirements.
Collaborate with health plans regarding authorization requirements, continued stay, level of care, referrals, discharge planning, and transitions of care.
Monitor and utilize HICE metrics to assess utilization management performance, identify trends, and support process improvement.
Apply NCQA guidelines and accreditation standards to utilization management workflows and clinical review processes.
Led a team in developing, standardizing, and documenting Standard Operating Procedures (SOPs) for the Managed Care Liaison role to promote consistency, efficiency, and reliable execution of department processes.
Trained and onboarded new and existing employees on UM workflows, including referral entry, health plan website navigation, InterQual utilization, Athena IDX, and Cerner systems.
Provide ongoing education and support to team members regarding payer requirements, referral workflows, utilization management processes, and post-acute care.
Promote quality and cost-effective care through appropriate utilization of healthcare resources while maintaining focus on patient safety and regulatory requirements.

Unit Manager

ESKATON MANZANITA CARE CENTER

01.2013 - 01.2016

Provided clinical and operational leadership for a skilled nursing unit while managing a 45-member staff.
Supervised, coached, mentored, and supported nursing staff to promote safe, high-quality patient care and effective daily operations.
Coordinated staffing, assignments, patient care activities, and workflow to optimize clinical outcomes and operational efficiency.
Oversaw patient assessments, care planning, clinical documentation, medication administration, treatments, and changes in patient condition.
Collaborated with physicians, rehabilitation services, social services, families, and interdisciplinary teams to coordinate individualized patient care.
Monitored clinical documentation for accuracy and consistency to ensure compliance with patient care standards and regulatory requirements.
Provided staff education, coaching, mentoring, and performance feedback.
Addressed clinical and operational concerns and facilitated effective communication among nursing staff, providers, residents, families, and interdisciplinary team members.
Cultivated leadership, delegation, problem-solving, and team-management skills to enhance effectiveness in unit management.

LVN Experience- Skilled Nursing Facilities

Multiple

01.2007 - 01.2013

Progressively developed clinical expertise in patient assessment, care planning, medication administration, treatments, clinical documentation, patient education, and interdisciplinary care.
Developed the clinical foundation that supports current utilization management, medical necessity review, care coordination, and managed care expertise.

Education

Bachelor of Science in Nursing (BSN) -

Nightingale College

08-2026

Skills

Utilization Management Operations: Prior Authorization, Concurrent Review, InterQual Criteria, Medical Necessity, Referral Review
Compliance & Quality: Health Plan Requirements, Audits, Appeals & Denials, HICE Metrics, NCQA Guidelines, Quality Improvement, SOPs
Leadership & Operations: Staff Training, Workflow Coordination, Performance Monitoring, SNF Utilization, Physician Collaboration

Care Coordination: Transitions of Care, Case Management Education, Interdisciplinary Teams
Systems & EHR: Athena IDX, Cerner, Health Plan Portals, InterQual
InterQual Athena IDX Cerner Health Plan Portals Microsoft Office EHR Systems