Ashley Griffith
WellStar
Williamson,GA
25
years of professional experience
Seasoned nursing professional offering proven clinical knowledge, interpersonal strengths and technical abilities. Critical thinker and problem-solver. Knowledgeable about EMR charting, medication administration and interdisciplinary collaboration focused on optimizing patient care and support. Quality-focused and efficiency-driven. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Work History
Utilization Management Nurse
6 Years 6 Months- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Conducted admission reviews to assess medical necessity.
- Secured authorizations from various insurance carriers for multiple levels of care.
- Developed expertise in utilization processes to enhance service delivery in multiple areas including Med/Surg, Critical Care, Mother/Baby, Labor & Delivery, NICU and Women's services.
- Experience with EPIC, MCG, InterQual, Gammis, Availity and other insurance portals.
- Handled denial reviews and managed appeals for insurance claims, AOR and Peer to Peers.
- Ensured compliance with Medicare and Medicaid guidelines in all utilization management activities.
- Mentored junior nursing staff on utilization management protocols and processes.
Care Coordinator/Utilization Management Nurse
5 Years 4 Months- Managed patient referrals and follow-ups, enhancing continuity of care across departments.
- Coordinated patient care services to ensure timely and effective treatment plans.
- Collaborated with multidisciplinary teams to streamline communication and improve care transitions.
- Facilitated discharge planning: Set up HH, IV infusions, Hospice, DME, Rehab and SNF placement, ensuring seamless transitions from hospital to home or facilities.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed admission reviews for medical necessity.
- Experience with Denials, AOR and Peer to Peer.
Nursing Unit Manager
1 Year 4 Months- Unit Manager for Skilled Nursing Facility Long Term care. Ensured compliance with state and federal guidelines to maintain high standards of care.
- Evaluated and monitored care and services throughout shift to improve quality levels.
- Coordinated nursing activities and staffing with health-related, therapeutic and support services to streamline service delivery.
- Created and assigned nursing tasks to unit staff, clarifying roles and responsibilities for efficient care delivery.
- Established IV lines to ensure efficient medication delivery and administered IV therapy as needed.
Registered Nurse
10 Years 4 Months- Collaborated with physicians to assess Hematology/Oncology patients, ensuring timely delivery of chemotherapy and appropriate treatment plans.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process and management and lifestyle options.
- Trained new nurses on techniques, care standards, operational procedures, and safety protocols to enhance team competency and patient care quality.
- Mixed and administered IV Chemotherapy.
- Coordinated transfusions, home health, and outpatient care.
- Identified patients requiring financial assistance, guiding them through application processes to secure support from foundations.
- Entered Chemotherapy Protocols in EMR.
Registered Nurse Medical/Surgical and Oncology
1 Year 5 Months- Educated patients and families on medical-surgical procedures, therapeutic regimens, and pain management techniques to enhance understanding and compliance.
- Managed simultaneous caseload of patients by delivering bedside care, treatments, IV therapy, and wound care, ensuring quality patient outcomes.
- Initiated intravenous fluids, administered medications, and documented patient charts, accurately recording food and fluid output and intake for comprehensive patient monitoring.
- Completed certification in chemotherapy administration to enhance patient care.
Education
Associate Degree in Nursing - Nursing
Skills
Excellent Time Management
Ability to work independently and self motivated
Team player and willing to help coworkers to even workload and ensure completion.
Take great pride in ensuring health care services are administered with cost efficiency and within compliance.
Comprehensive knowledge of EPIC
MCG
InterQual
Microsoft Word
Outlook and Excel.
Proficient with Insurance portals such as Availity and Gammis.
Well experienced in obtaining authorizations
determining medical necessity
reviewing denials
setting up peer to peers and correcting patient class to match level of care.
Timeline
Utilization Management Nurse
WellStar
02.2020 - CurrentRead More
Care Coordinator/Utilization Management Nurse
Wellstar Spalding Regional Hospital
10.2014 - 02.2020Read More
Nursing Unit Manager
Renaissance Center
06.2013 - 10.2014Read More
Registered Nurse
Ga Cancer Specialists
10.2002 - 02.2013Read More
Registered Nurse Medical/Surgical and Oncology
Spalding Regional Hospital
05.2001 - 10.2002Read More
Georgia Perimeter College
Associate Degree in Nursing from Nursing
Read More