Summary
Overview
Work History
Education
Skills
Certification
References
Timeline
RegisteredNurse

Amanda Thomas

Smithfield,VA

Summary

Experienced leader with a strong background in team guidance, project management, and strategic objective achievement. Excels in developing efficient processes, maintaining high standards, and aligning efforts with organizational goals. Known for a collaborative approach and unwavering commitment to excellence.

Overview

19
19
years of professional experience
2
2
Certification

Work History

Team Coordinator

Sentara Health Plans
06.2021 - Current
  • Assumed responsibility, accountability, and leadership for daily operations including coordination of work, quality, and service, as well as daily work assignment and board management with primary focus on compliance, timeliness, and quality reviews for prior authorization department
  • Provided leadership role in ongoing utilization review nurse competency assessment, needs identification and educational offerings, including monthly trainings and case study reviews
  • Collaborated across departments and divisions to promote needs facilitation of members
  • Organized and facilitated education and training for new hires and provided ongoing education to current staff to promote standardization of authorization review process and standards, including development of policies and procedures for department
  • Possess in-depth knowledge and application of Medicaid, Medicare and NCQA compliance and contractual standards as well as application of evidenced-based medical necessity criteria, such as MCG Health
  • Developed and implemented remote onboarding and ongoing training program for utilization review nurses.
  • Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
  • Evaluated staff performance and provided coaching to address inefficiencies.
  • Devised and implemented processes and procedures to streamline operations.
  • Oversaw staffing, scheduling and planning for 20 employees on prior authorization utilization management team.

Integrated Care Manager

Optima Health Insurance
01.2019 - 06.2021
  • Promoted standardization of documentation and authorization review with implementation of orientation program, job aids and new-hire tools
  • Engaged in collaboration with other departments in reviewing processes, including medical directors, networking matters, and policy updates and clarification
  • Implementation of effective utilization and monitoring of healthcare resources for government programs population
  • Execution of successful telecommuting and work-from-home program
  • Communicated with healthcare providers to facilitate continuity of care.
  • Maintained detailed records in compliance with agency standards and regulations.
  • Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.

Integrated Care Manager

Optima Health Insurance
03.2014 - 01.2019
  • Promoted effective utilization and monitoring of healthcare resources, collaboration and communication with medical directors and care team to manage care of members and transitions of care
  • Effectively assessed and coordinated members care, created cost effective plans of care, identified risks, and high utilization inpatient level of care cases
  • Mentored/Role modeled professional practice that is consistent with organizational goals, customer service, clinical effectiveness, and standards of care for concurrent inpatient and post acute care
  • Team preceptor/mentor; performed new hire orientation and competency training.
  • Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
  • Submitted cases for criteria failures and helped facilitate resolutions and approvals.

Clinical Research Nurse Coordinator

Cardiovascular Associates, Ltd.
02.2008 - 03.2014
  • Management of clinical trial manuals and regulatory documentation and conduct patient interviews, recruitment, and enrollment
  • Screened patient records, databases, and physician referrals to identify prospective candidates for research studies.
  • Complied with research protocols by providing ongoing quality control audits.
  • Worked with principal investigator and sponsors to facilitate daily trial activities and comply with research protocols.
  • Collected, evaluated, and modeled collected data.
  • Gathered, processed, and shipped lab specimens.

Registered Nurse, Labor and Delivery

Sentara Leigh Hospital
01.2007 - 02.2008
  • Utilized assessment skills and critical thinking to monitor laboring patients during their labor and delivery process as well as administration of high-risk medications, including Oxytocin
  • Assisted physician during delivery, examination and surgical procedures by anticipating needs, encouraging patient, and attending to baby after birth.
  • Coached new mothers with breastfeeding techniques, postpartum self-care and infant care to promote easier transition into motherhood.

Registered Nurse

Sentara Heart Hospital
12.2005 - 01.2007
  • Provided bedside clinical nursing care for pre and post heart transplant patients, congestive heart failure and step-down cardiac surgery patients
  • Coordinated plans of care with physicians and care team Monitored and interpreted telemetry stops, lab results and vital signs of patient population
  • Used critical thinking to institute appropriate measures according to testing results and changes to patient’s condition
  • Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use, and disease management.
  • Provided care to patients with Ventricular Assist Devices

Education

Bachelor of Science - Nursing

Western Governors University
Millcreek, UT
06.2018

No Degree - Nursing

Sentara School of Health Professions
Chesapeake, VA
12.2005

Skills

  • Process improvement strategies
  • Project management experience
  • Performance Management
  • Staff Management
  • Continuous Improvement
  • Meeting facilitation
  • Change Management
  • Productivity Improvement
  • Excellent Communication
  • Workflow Optimization

Certification

  • Registered Nurse, Virginia, 0001199041
  • Nursing Case Management, RN-BC, 09/2021 - Current
  • MCG Certification, 03/2024 - 03/2026

References

References provided upon request.

Timeline

Team Coordinator

Sentara Health Plans
06.2021 - Current

Integrated Care Manager

Optima Health Insurance
01.2019 - 06.2021

Integrated Care Manager

Optima Health Insurance
03.2014 - 01.2019

Clinical Research Nurse Coordinator

Cardiovascular Associates, Ltd.
02.2008 - 03.2014

Registered Nurse, Labor and Delivery

Sentara Leigh Hospital
01.2007 - 02.2008

Registered Nurse

Sentara Heart Hospital
12.2005 - 01.2007

Bachelor of Science - Nursing

Western Governors University

No Degree - Nursing

Sentara School of Health Professions

Similar Profiles

  • Hubert OosthuizenHubert Oosthuizen

    Warehouse Team Leader /Line Manager at Smart SystemsWarehouse Team Leader /Line Manager at Smart Systems

  • DEEPAK KUMAR SAJWARDEEPAK KUMAR SAJWAR

    <ul><li>Profile: Record to Reporting (R2R)</li><li>Performing financial reporting and controlling for across all the entities (in Hyperion and Oracle = JD Edward).</li><li>Performing End to End P&L finalization (Review of accruals, Negative Cash Accrual, prepaid amortization schedule, FX Adjustments, creation, deletion and capitalization of fixed assets, posting of depreciation etc.) & taking calls with Controllers during Months end for further review of P&L.</li><li>Banking process includes positive pay exceptions, stop payment, voiding checks with AP team. Checks movement to unclaimed property. Payment proof, remittance details.</li><li>IFRS lease computation complying with IFRS 16 in CoStar – Real Estate Manager system (this is only for lease).</li><li>Preparation of webforms and variance analysis report and sharing with stakeholders with detailed information.</li><li>Performing Balance sheet reconciliation with adherence of policy and clearance of open items along with relevant details of lines which is overaged however will be staying for long time (i.e.- Bonus and dividends, Common Stocks, Security Deposits).</li><li>Facilitating team operations by discussions through the sharing of information and knowledge, identification of teamwork issues, development of problem-solving recommendations, and recommendations of standardizing team operations.</li><li>Cross train resources in order to have backup of each other to help team synergy helping team members to take leaves when required without bothering of work/process deliverables.</li><li>Conduct weekly, biweekly and monthly meetings with stake holders as per their agreement.</li><li>Create opportunities for team members to provide input on procedures/processes and share their expertise with other team members.</li><li>Working knowledge of ERP systems People Soft, ART (Reconciliation software of Oracle), JD Edward, Teradata, Cetova, Hyperion (HFM), Cadency, Blackline, SAP, NetSuite, Workday Adaptive, Coupa, Tableau, CoStar, Alteryx.</li><li>PROCESS IMPROVEMENTS</li><li>Given 12 lean ideas in area of Month End Close journals, Balance Sheet Reconciliations, and Bank Reconciliations.</li><li>Part of a green belt project on quality of reconciliations and BOT implementation (work in progress) – controllership impact</li><li>Bring automation & Marco enabling dash board MIS reporting for monthly SLA, KPI, IC balances, Cash forecasting etc.</li></ul> at Genpact India Pvt. Ltd<ul><li>Profile: Record to Reporting (R2R)</li><li>Performing financial reporting and controlling for across all the entities (in Hyperion and Oracle = JD Edward).</li><li>Performing End to End P&L finalization (Review of accruals, Negative Cash Accrual, prepaid amortization schedule, FX Adjustments, creation, deletion and capitalization of fixed assets, posting of depreciation etc.) & taking calls with Controllers during Months end for further review of P&L.</li><li>Banking process includes positive pay exceptions, stop payment, voiding checks with AP team. Checks movement to unclaimed property. Payment proof, remittance details.</li><li>IFRS lease computation complying with IFRS 16 in CoStar – Real Estate Manager system (this is only for lease).</li><li>Preparation of webforms and variance analysis report and sharing with stakeholders with detailed information.</li><li>Performing Balance sheet reconciliation with adherence of policy and clearance of open items along with relevant details of lines which is overaged however will be staying for long time (i.e.- Bonus and dividends, Common Stocks, Security Deposits).</li><li>Facilitating team operations by discussions through the sharing of information and knowledge, identification of teamwork issues, development of problem-solving recommendations, and recommendations of standardizing team operations.</li><li>Cross train resources in order to have backup of each other to help team synergy helping team members to take leaves when required without bothering of work/process deliverables.</li><li>Conduct weekly, biweekly and monthly meetings with stake holders as per their agreement.</li><li>Create opportunities for team members to provide input on procedures/processes and share their expertise with other team members.</li><li>Working knowledge of ERP systems People Soft, ART (Reconciliation software of Oracle), JD Edward, Teradata, Cetova, Hyperion (HFM), Cadency, Blackline, SAP, NetSuite, Workday Adaptive, Coupa, Tableau, CoStar, Alteryx.</li><li>PROCESS IMPROVEMENTS</li><li>Given 12 lean ideas in area of Month End Close journals, Balance Sheet Reconciliations, and Bank Reconciliations.</li><li>Part of a green belt project on quality of reconciliations and BOT implementation (work in progress) – controllership impact</li><li>Bring automation & Marco enabling dash board MIS reporting for monthly SLA, KPI, IC balances, Cash forecasting etc.</li></ul> at Genpact India Pvt. Ltd

  • Nicholas JuzdowskiNicholas Juzdowski

    Process Coordinator/Order Management Specialist at Signify (Formerly Philips Lighting)Process Coordinator/Order Management Specialist at Signify (Formerly Philips Lighting)

  • Ketshepile G. NthomiwaKetshepile G. Nthomiwa

    Performance Improvement Coordinator at Directorate On Corruption And Economic Crime-DCECPerformance Improvement Coordinator at Directorate On Corruption And Economic Crime-DCEC

CREATE PROFILE
Amanda Thomas