Barbara Gay Parker
Grady Hospital
Hampton,GA
1
Certification
27
years of professional experience
Seasoned nursing professional with a strong background in case management, utilization review, and interdisciplinary care coordination. Known for sound clinical judgment, accurate documentation, and compliance with regulatory and payer requirements. Delivers safe transitions, effective advocacy, and efficient resource use.
Work History
Case Manager/Utilization Review Nurse
18 Years 7 Months- Completed psychosocial assessments to identify barriers affecting care access and continuity.
- Coordinated discharge planning with interdisciplinary teams to support safe, timely patient transitions.
- Linked patients with community resources, behavioral health services, and post-discharge support.
- Documented case management activities in electronic health records with accuracy and consistency.
- Collaborated with physicians, nurses, and social workers to resolve care coordination issues.
- Monitored utilization review requirements to support appropriate level-of-care decisions.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
- Facilitated patient advocacy by explaining treatment plans, benefits, and follow-up needs.
- Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
- Enhanced communication between clients and providers through consistent follow-ups and progress updates.
- Contributed to team discussions and case conferences actively, sharing insights and expertise with colleagues to optimize client support strategies.
- Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
- Reviewed inpatient and outpatient cases for medical necessity using established utilization review criteria.
- Coordinated concurrent reviews with physicians, case managers, and payers to support appropriate level of care.
- Interpreted clinical documentation to determine authorization requirements and continued stay appropriateness.
- Communicated denial, appeal, and peer-to-peer review decisions with clear clinical rationale.
- Maintained compliance with regulatory requirements, payer policies, and internal utilization review protocols.
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
- Served as a vital liaison between patients, healthcare providers, and insurance companies, fostering effective communication and coordination among all parties involved in the care process.
- Fostered a culture of continuous learning by actively participating in departmental meetings, trainings, and continuing education opportunities related to utilization review.
Senior Staff Nurse
8 Years 2 Months- Assessed complex patient conditions and prioritized nursing interventions across acute care settings.
- Administered medications, IV therapies, and treatments while maintaining medication safety and documentation accuracy.
- Coordinated multidisciplinary care plans with physicians, case managers, and ancillary staff.
- Mentored nursing staff on clinical procedures, workflow standards, and patient safety practices.
- Monitored patient status, responded to changes, and escalated concerns using clinical judgment.
- Documented assessments, interventions, and progress notes in electronic health records.
- Educated patients and families on treatment plans, discharge instructions, and self-care needs.
- Supported unit operations by managing admissions, transfers, and continuity of care.
- Facilitated patient discharges by coordinating with medical teams, social workers, case managers, and other support staff.
- Enhanced patient care by implementing evidence-based nursing practices and maintaining up-to-date knowledge on industry advancements.
- Assisted in staff recruitment efforts, conducting interviews and evaluating candidates for open nursing positions.
- Precepted student nurses and oriented new hires, providing guidance and mentorship when teaching on hospital policies, emergency procedures, and nursing best practices.
Education
Master of Science - Nursing Leadership And Management
Bachelor of Science - Nursing Practice
Skills
Utilization review
Case management
Clinical assessment
Case documentation management
Documentation management
Patient communication
Healthcare regulations
Medicare
Medicaid
Data interpretation
Regulatory compliance
Records analysis
Critical thinking
Problem-solving
Time management
Written communication
Professional etiquette
Certification
- Certified Case Manager License - 2008-current
- BCLS
- Interqual Certified Instructor
Timeline
Case Manager/Utilization Review Nurse
Grady Hospital
04.2008 - CurrentRead More
Senior Staff Nurse
Grady Hospital
04.2000 - 06.2008Read More
Western Governors University
Master of Science from Nursing Leadership And Management
Read More
Clayton State University
Bachelor of Science from Nursing Practice
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