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
IV Certified
BLS
Similar Profiles
Lysette PerezLysette Perez
Clinic LPN at P3 Health PartnersClinic LPN at P3 Health Partners
Susan BayneSusan Bayne
Care Experience Navigator at P3 Health PartnersCare Experience Navigator at P3 Health Partners
Latrivia Nance-SeiduLatrivia Nance-Seidu
Practice Manager at P3 Health Partners Medical GroupPractice Manager at P3 Health Partners Medical Group