Amy Ham
Stockton,CA
Summary
Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Utilization Manager
P3 Health Partners
08.2019 - 03.2024
- Provided training and mentorship to new team members, fostering a collaborative work environment focused on achieving departmental goals.
- Enhanced patient care by conducting thorough utilization reviews and coordinating with healthcare providers.
- Served as a liaison between clinical staff, administrative personnel, and external stakeholders for all matters related to utilization management, facilitating clear communication across all parties involved.
- Developed internal policies and procedures related to utilization management, resulting in improved efficiency throughout the department.
- Conducted comprehensive audits of medical records to ensure compliance with regulatory requirements and best practices in healthcare management.
- Streamlined approval processes for medical procedures, ensuring efficient and timely patient care.
- Maintained up-to-date knowledge of industry trends, regulations, and guidelines, contributing to the continuous improvement of utilization management practices within the organization.
- Increased staff efficiency by providing ongoing education on proper documentation techniques necessary for accurate claims processing.
Utilization Review Nurse
P3 Health Partners
07.2013 - 08.2019
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Increased staff efficiency by providing ongoing education on proper documentation techniques necessary for accurate claims processing.
LVN Floor Nurse
Dameron Hospital
02.2001 - 04.2013
- Worked under registered nurses to care for patients and manage basic care.
- Participated in ongoing professional development opportunities to stay current on best practices in nursing care and maintain licensure requirements.
- Contributed to a safe working environment by following infection control protocols and accurately reporting incidents or concerns.
- Collected and documented vital signs to maintain current records of patients' conditions.
- Provided patient care in Orthopedics, Telemetry, General surgery, Post-partum care.
- Enhanced patient care by implementing individualized nursing plans and effectively collaborating with interdisciplinary team members.
- Provided emotional support to patients and their families, fostering trust and open communication during difficult times.
- Reduced medication errors through meticulous attention to detail when administering treatments and medications.
- Demonstrated strong clinical judgment when assessing patients, prioritizing needs, and initiating appropriate interventions.
Education
Vocational Nurse - Nursing
San Joaquin Delta College
Stockton, CA12.1999
Skills
- Critical thinking abilities
- Documentation accuracy
- Hiring and Training
- Goal Setting
- Process improvement strategies
- Teamwork and Collaboration
- Computer Skills
- Decision-Making
- Problem Resolution
- Health Plan Audits
- CMS Audits
- Medicare and Commercial LOB
- Appeals and Grievance
- Maintaining Compliance
- Collaboration with IT
- Policy and Procedures
- Professional and Courteous
- Work Planning and Prioritization
- Scheduling and Coordinating
- Task Delegation
- Performance Evaluations
- Business Planning
Certification
IV Certified
BLS
Timeline
Utilization Manager
P3 Health Partners
08.2019 - 03.2024
Utilization Review Nurse
P3 Health Partners
07.2013 - 08.2019
LVN Floor Nurse
Dameron Hospital
02.2001 - 04.2013
Vocational Nurse - Nursing
San Joaquin Delta College