Angela Loutraris, RN
Fort Lauderdale,FL
Summary
Healthcare management professional with extensive experience specializing in case and utilization management. Proven track record in establishing innovative medical teams and enhancing HEDIS/STAR measures through targeted quality improvement initiatives. Strong collaborative leadership skills and a commitment to staff development have led to consistently high-performance metrics and improved patient care outcomes.
Overview
35
35
years of professional experience
Work History
Manager of Case Management
UnitedHealth Group/ Optum
Remote Position
02.2023 - Current
- Facilitated the launch of a new home-based medical team in the Miami/Fort Lauderdale market
- Oversight of case management team of nurses and care coordinators
- Organization and coordination of daily operations of the team
- Hire, train, coach, counsel and evaluate staff performance according to company policy
- Ensure new processes and procedures are implemented
- Create innovative approaches and solutions to meeting metrics
- Emphasis with addressing HEDIS/STAR measures
- Participate in health plan directed audits
- Investigate customer's complaints and determine resolution
Manager of Utilization Management Inpatient Care
UnitedHealth Group/ Optum
Remote Position
08.2022 - 01.2023
- Oversight of inpatient care management team of nurses
- Organization and coordination of daily operations of the team
- Hire, train, coach, counsel and evaluate staff performance according to company policy
- Ensure new processes and procedures are implemented
- Create innovative approaches and solutions to meeting metrics
- Participate in health plan directed audits
- Investigate customer's complaints and determine resolution
- Member of the Document Review Committee ensuring Standard Operating Procedures (SOP) and job aides are reviewed and updated quarterly for the department
Manager of Utilization Management
UnitedHealth Group/ Optum
Hybrid Position
01.2016 - 07.2022
- Oversight of utilization management department consisting of 40 clinical and non-clinical staff
- Organization and coordination of daily operations of the team
- Hire, train, coach, counsel and evaluate staff performance according to company policy
- Ensure new processes and procedures are implemented
- Create innovative approaches and solutions to meeting metrics
- Participate in health plan directed audits
- Facilitated with NCQA/URAC department accreditation
- Investigate customer's complaints and determine resolution
Utilization Management Nurse Reviewer/Team Lead
United Health Group/ Optum
Plantation, FL
06.2013 - 12.2015
- Company Overview: Formerly Orthonet
- Review of prospective and retrospective requests for pain management to include injections, spinal cord stimulators and intrathecal pain pumps for the Medicare, Medicaid and Commercial populations utilizing CMS and health plan specific guidelines
- Clinical resource specialist supporting staff
- Formerly Orthonet
Telephonic Case Manager
Broadspire
Ft. Lauderdale, FL
01.2013 - 06.2013
- Coordinate and medically manage a range of health care services to designated injured workers through telephonic communication
- Collaboration with injured workers, employers, providers, claims adjusters and others, to determine if treatment is medically necessary, appropriate, and effective to secure a timely return to work status for the injured worker
Utilization Management Nurse Reviewer
Broadspire
Ft. Lauderdale, FL
04.2008 - 12.2012
- Review requests for medical care from Workers Compensation healthcare providers: precertifications, reconsiderations and appeals
- Utilize national and local jurisdictional guidelines to make determinations of medical necessity
- Discuss case information with claims adjusters and expert health care reviewers to ensure appropriate cost containment
Home Health R.N.
Jewish Family Home Care
Ft. Lauderdale, FL
01.2006 - 03.2008
- Field position responsible for client assessments and supervisory visits
Nurse Coordinator-Occupational Health R.N.
Federal Occupational Health
Ft. Lauderdale, FL
09.2003 - 03.2008
- Supervisory position responsible for managing all facets of a Federal Employee clinic operation and staff; focusing on preventive care, performance of client physicals, and creating health awareness
Per Diem/Staff Relief R.N.
Memorial Healthcare
Pembroke Pines, FL
03.2000 - 01.2006
- Medical, Surgical, Telemetry and Respiratory Units
Home Health R.N.
Griswold Special Care
Tamarac, FL
12.2001 - 08.2005
- Field position, responsible for client assessments and supervisory visits
Staff R.N. / Charge Nurse
Lenox Hill Hospital
New York City, NY
06.1990 - 05.1998
- Medical, Surgical and Oncology Units
- Charge nurse responsible for delegation of responsibilities to floor staff R.N
- Patient education/preceptor responsible for orientation of new nursing staff
Education
BSN -
Hunter College
New YorkSkills
- Utilization/Case Management
- Audit
- Interdepartmental collaboration
- Care coordination
- Flexible
- Quality improvement
- Staff development
- HEDIS/STAR
- Documentation management
- Metrics/KPIs
- Forecasting and planning
- Priority management
- Computer knowledge
License and certification
Registered Nurse: Florida compact license, NY, HI, DC, OR, NJ, OH
Timeline
Manager of Case Management
UnitedHealth Group/ Optum
02.2023 - Current
Manager of Utilization Management Inpatient Care
UnitedHealth Group/ Optum
08.2022 - 01.2023
Manager of Utilization Management
UnitedHealth Group/ Optum
01.2016 - 07.2022
Utilization Management Nurse Reviewer/Team Lead
United Health Group/ Optum
06.2013 - 12.2015
Telephonic Case Manager
Broadspire
01.2013 - 06.2013
Utilization Management Nurse Reviewer
Broadspire
04.2008 - 12.2012
Home Health R.N.
Jewish Family Home Care
01.2006 - 03.2008
Nurse Coordinator-Occupational Health R.N.
Federal Occupational Health
09.2003 - 03.2008
Home Health R.N.
Griswold Special Care
12.2001 - 08.2005
Per Diem/Staff Relief R.N.
Memorial Healthcare
03.2000 - 01.2006
Staff R.N. / Charge Nurse
Lenox Hill Hospital
06.1990 - 05.1998
BSN -
Hunter College