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, UT06.2018
No Degree - Nursing
Sentara School of Health Professions
Chesapeake, VA12.2005
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
- Registered Nurse, Virginia, 0001199041
- Nursing Case Management, RN-BC, 09/2021 - Current
- MCG Certification, 03/2024 - 03/2026
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