Arlexsus Timmons
Harper Woods,MI
Summary
MSN-prepared nurse leader with progressive experience in utilization management, case management oversight, reimbursement optimization, and regulatory compliance. Proven record of aligning clinical documentation with medical necessity standards, strengthening managed care performance, and leading interdisciplinary teams to improve operational efficiency and financial outcomes.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Director of Nursing
Medilodge of Rochester Hills
01.2024 - Current
- Directed clinical operations while aligning documentation practices with reimbursement and regulatory standards.
- Partnered with finance and administration to improve revenue cycle integrity and length-of-stay management.
- Led QAPI initiatives focused on readmission reduction and compliance performance.
Critical Care Registered Nurse
Select Specialty Hospital
01.2023 - Current
- Provide high-acuity care in a regulated LTACH setting while supporting interdisciplinary care coordination and compliant documentation practices.
Director of Nursing
Rivergate Terrace
01.2022 - 01.2024
- Oversaw quality metrics including rehospitalization rates and documentation accuracy.
- Strengthened managed care alignment through structured case review and interdisciplinary collaboration.
MDS Coordinator / Reimbursement Specialist
Advantage Living Center
01.2019 - 01.2022
- Led utilization review and Triple Check meetings ensuring Medicare and managed care compliance.
- Managed caseloads of up to 50 residents, aligning documentation with medical necessity criteria.
- Conducted reimbursement audits and collaborated with interdisciplinary teams to reduce denials and optimize payment outcomes.
- Supported discharge planning and level-of-care determinations through structured case review.
MSN Leadership Practicum
Rehabilitation Institute of Michigan
- Led audit-based process improvement initiatives to standardize patient supervision workflows.
- Conducted baseline compliance reviews and developed reporting tools to support risk mitigation and performance improvement.
Education
Master of Science in Nursing (MSN) - Leadership
Chamberlain University
Associate of Applied Science -
Nursing
Skills
- Utilization Management (UM) Leadership
- Case Management Program Oversight
- Medicare & Managed Care Operations
- Triple Check & Revenue Integrity
- Medical Necessity & Level-of-Care Determination
- Reimbursement Optimization & Denial Mitigation
- Regulatory Compliance & Audit Readiness
- Process Improvement & Workflow Standardization
- Cross-Functional & Client Collaboration
- Data Analysis & Performance Reporting
Certification
- Registered Nurse, Michigan, Active
- RAC-CT, Resident Assessment Coordinator Certified
- SWOC, Skin, Wound, Ostomy Certified
- BLS
- ACLS
Credentials
- MSN
- RN
- RAC-CT
- SWOC
Timeline
Director of Nursing
Medilodge of Rochester Hills
01.2024 - Current
Critical Care Registered Nurse
Select Specialty Hospital
01.2023 - Current
Director of Nursing
Rivergate Terrace
01.2022 - 01.2024
MDS Coordinator / Reimbursement Specialist
Advantage Living Center
01.2019 - 01.2022
MSN Leadership Practicum
Rehabilitation Institute of Michigan
Master of Science in Nursing (MSN) - Leadership
Chamberlain University
Associate of Applied Science -
Nursing