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Ariadne D. Hulsey, RN
Registered Nurse
Garfield,AR
Summary
Well rounded Registered Nurse with over 15 years of expertise in the healthcare industry. A triple-certified specialist (CMAC, ACM-RN, CCM) with expertise in ensuring regulatory compliance and coordinating complex inpatient and outpatient care. Experienced in conducting thorough assessments and creating care plans to meet client needs. Well versed in collaborating with multidisciplinary teams to advocate for and support clients. Recognized for exceptional analytical precision, critical thinking and problem-solving skills in dynamic situations to ensure optimal client outcomes. I am looking to put my knowledge and skills into action providing high-quality focused care to those we serve.
Overview
4
4
Certification
15
15
years of professional experience
Work History
Inpatient Utilization Management RN
Wellmed Medical Management (Optum)
Remote
01.2025 - Current
- Execute high-priority clinical necessity reviews for unplanned inpatient admissions, ensuring strict alignment with MCG guidelines and Medicare Advantage standards.
- Manage critical authorizations for high-cost services, including Durable Medical Equipment (DME) and emergency/non-emergency ambulance transport.
- Proactively identify and report clinical inconsistencies or procedural gaps to leadership, contributing to improved departmental standardization and audit readiness during the Optum integration.
- Consistently exceed production and quality benchmarks by leveraging advanced certification knowledge and a deep understanding of utilization metrics.
- Completed advanced 3-level "Medicare and Retirement" professional curriculum, demonstrating subject matter expertise in Medicare products and regulatory compliance.
Senior Care Manager
Health Net Federal Services
Remote
06.2021 - 12.2024
- Selected to manage a specialized, high acuity, high cost 20-member medically complex group of active duty military family members, providing direct clinical reporting and auditing status updates to the Defense Health Agency (DHA).
- Oversaw case management for members with severe intellectual and physical disabilities, facilitating consistent care and adherence to intricate regulatory standards while optimizing resource allocation and reducing service gaps for beneficiaries.
- Managed authorization processes for ECHO/EHHC extended private duty nursing, maintaining strict compliance with medical necessity standards and federal guidelines.
- Negotiated service hours and rates with home health providers, focusing on delivering comprehensive care for military families while minimizing expenses for the payor.
Inpatient Case Manager / Utilization Management
Wellmed Medical Management
Remote
02.2020 - 06.2021
- Facilitated collaboration among multidisciplinary teams to enhance transitions of care for Medicare Advantage members into LTAC, IPR, SNF, and HHC settings.
- Collaborated with interdisciplinary teams to optimize patient outcomes and resource utilization.
- Evaluated medical necessity criteria based on evidence-based guidelines, improving approval rates for services.
Case Manager / Utilization Review Nurse
Christus Spohn Health Systems
Corpus Christi, TX
10.2016 - 02.2020
- Engaged with IT and software representatives to create and test an automated patient-sorting process, streamlining operations for UM nurses.
- Led development of new ER screening department. Created operational manuals and supported training for incoming clinical staff.
- Executed intricate MCG denial reviews and orchestrated peer-to-peer physician discussions to confirm appropriate admission status and adherence to medical necessity guidelines.
Registered Nurse
Northwest Health Systems
Springdale, AR
04.2013 - 10.2016
- Delivered specialized nursing care for high-risk patients in antepartum, labor and delivery, postpartum, and surgical settings to ensure optimal patient outcomes.
- Designed and implemented detailed perinatal curriculum to enhance educational resources for expectant parents.
- Analyzed patient health status to detect changes swiftly, ensuring immediate notification of physicians and implementation of appropriate care strategies.
- Delivered comprehensive nursing care focused on compassion, effectively addressing patients' physical, emotional, and spiritual well-being to improve overall satisfaction.
Education
Associate of Science - Nursing
Northwest Arkansas Community College
Bentonville, ARAssociate of Science - Accounting
Southwestern Iowa Community College
Creston, IASkills
- Discharge Planning
- Medicare Advantage expertise
- Proficient in MCG standards
- Knowledge of CMS compliance
- Clinical documentation software expertise
- Proficient with Microsoft Office applications
- Active listening
- Time management
- Decision-making
- Problem solving
- Client advocacy
- Critical thinking
- Adaptable to change
- Resource management
- Interdisciplinary collaboration
- Expertise in HIPAA compliance
- Documentation and reporting
- Effective motivational interviewing
Certification
- Registered Nurse (RN) | Arkansas State Board of Nursing | #R089863 | Exp. 04/2027
- CMAC (Case Management Administration Certification) | #C11154567| Exp. 03/2030
- CCM (Certified Case Manager) | #4237295 | Exp. 05/2028
- ACM-RN (Accredited Case Manager) | #76786 | Exp. 07/2027
Timeline
Inpatient Utilization Management RN
Wellmed Medical Management (Optum)
01.2025 - Current
Senior Care Manager
Health Net Federal Services
06.2021 - 12.2024
Inpatient Case Manager / Utilization Management
Wellmed Medical Management
02.2020 - 06.2021
Case Manager / Utilization Review Nurse
Christus Spohn Health Systems
10.2016 - 02.2020
Registered Nurse
Northwest Health Systems
04.2013 - 10.2016
Associate of Science - Nursing
Northwest Arkansas Community College
Associate of Science - Accounting
Southwestern Iowa Community College