Amy Highers
Attica,NY
Summary
Seasoned Director with background in strategic planning, team leadership, and performance optimization. Known for driving company growth by developing efficient operational strategies and fostering professional relationships. Demonstrated abilities in problem solving, decision making, and communication skills to influence key stakeholders. Proven record of delivering innovative solutions and achieving organizational goals.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Director of Utilization Management
Excellus BCBS
Rochester, NY
07.2022 - Current
- Oversaw strategic planning and implementation to ensure organizational goals were met.
- Managed budgeting and financial planning processes for the department .
- Identified opportunities for improvement in operational performance metrics.
- Delegated work to staff, setting priorities and goals.
- Coordinated with regulatory bodies to ensure compliance with laws and standards.
- Coordinated activities with other departments to expedite work and improve collaboration.
- Promoted a culture of innovation and encouraged staff to contribute ideas.
Manager of Utilization Management
Excellus BCBS
Rochester, NY
06.2019 - 07.2022
- Oversaw daily operations, maintaining efficiency and quality standards.
- Coached, mentored and trained team members in order to improve their job performance.
- Ensured compliance with all applicable laws, regulations, industry standards.
- Led team meetings and one-on-one coaching sessions to continuously improve performance.
- Established processes to ensure efficient workflow throughout the organization.
- Interviewed prospective employees and provided input to HR on hiring decisions.
Utilization Review Nurse
Excellus BCBS
Rochester, NY
01.2018 - 06.2019
- Identified opportunities for improvement in processes related to utilization management functions.
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
- Reviewed and updated utilization review criteria and guidelines to reflect current standards of practice.
- Provided feedback to healthcare providers on clinical documentation improvement to support utilization review.
Registered Nurse
Niagara Falls Memorial Medical Center
Niagara Falls, NY
02.2016 - 11.2018
- Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
- Monitored vital signs, administered injections, and provided assistance with medical procedures.
- Conducted intake assessments with patients and relatives to gather case history.
- Updated charts throughout shifts with current, accurate information to maintain strict recordkeeping standards.
- Demonstrated ability to work independently as well as collaboratively within a team environment.
Utilization Review Nurse
Excellus BCBS
Syracuse, NY
11.2012 - 01.2016
- Provided feedback to healthcare providers on clinical documentation improvement to support utilization review.
- Assisted in developing and implementing training programs for new utilization review staff.
- Performed discharge planning including referrals for post-acute care services when appropriate.
- Assessed the appropriateness of medical services and procedures based on clinical documentation and criteria.
NICU Registered Nurse
Crouse Irving Memorial Hospital
Syracuse, NY
07.2006 - 11.2012
- Delivered information regarding care and medications to patients and caregivers in comprehendible terminology.
- Evaluated patient vital signs and laboratory data to assess needs and provide emergency interventions.
- Instructed medical students, nursing students, residents and fellows on the care of premature infants.
- Maintained accurate records of patient assessments, treatments administered and changes in condition.
- Conducted parent education on neonate care, feeding techniques, and home healthcare requirements.
- Assessed patient's responses to treatments and interventions, adjusting plans accordingly.
- Monitored ventilator settings, oxygen saturation levels and other respiratory equipment.
- Monitored and adjusted environmental parameters within the NICU to ensure optimal conditions for neonate health.
Education
Master of Science - Health Care Administration
Utica College
Utica, NY05-2015
Bachelor of Science - Nursing
Utica College
Utica, NY05-2013
Associate of Applied Science - Nursing
Crouse Hospital School of Nursing
Syracuse, NY05-2006
Skills
- Utilization management
- Regulatory compliance
- Budget management
- Operational performance
- Team leadership
- Process improvement
- Clinical documentation
- Strategic planning
- Collaboration skills
- Effective communication
Affiliations
- Card Making
- Gardening
Certification
- Dale Carnegie Participant
Timeline
Director of Utilization Management
Excellus BCBS
07.2022 - Current
Manager of Utilization Management
Excellus BCBS
06.2019 - 07.2022
Utilization Review Nurse
Excellus BCBS
01.2018 - 06.2019
Registered Nurse
Niagara Falls Memorial Medical Center
02.2016 - 11.2018
Utilization Review Nurse
Excellus BCBS
11.2012 - 01.2016
NICU Registered Nurse
Crouse Irving Memorial Hospital
07.2006 - 11.2012
Master of Science - Health Care Administration
Utica College
Bachelor of Science - Nursing
Utica College
Associate of Applied Science - Nursing
Crouse Hospital School of Nursing
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