Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Barbara Lohmar

Weymouth,MA

Summary

Dynamic Utilization Review Nurse Clinical Coordinator at Massachusetts General Hospital, adept at enhancing patient outcomes through meticulous clinical documentation and effective communication. Demonstrated expertise in InterQual criteria and a commitment to teamwork, successfully reducing healthcare costs while fostering a culture of continuous learning and improving nursing satisfaction.

Smart Utilization Review Nurse considered critical thinker and problem-solver due to dynamic patient care planning and understanding of Medicare guidelines. Known for having great rapport with providers and insurance carriers.

Overview

13
13
years of professional experience
1
1
Certification

Work History

Utilization Review Nurse Clinical Coordinator

Massachusetts General Hospital
03.2013 - Current
  • Oversaw daily operations of Utilization Review team. Approximately 22+ staff members including:
  • Daily Assignment
  • Scheduling & staffing
  • Onboarding new staff members including orientation scheduling
  • Precepting new staff members
  • Full Assignment
  • IQ Instructor
  • Answering questions & giving guidance to staff
  • Reviewing Medicare pt & following the 2MN rule
  • Sending & speaking with payers for hospital reimbursement
  • Discussing & reviewing cases with physicians about particular patients.
  • Assisted in identifying potential gaps in healthcare services and resources for patients.
  • Reviewed clinical documentation to support utilization management and compliance standards.
  • Monitored trends in utilization patterns to inform recommendations for process improvements.
  • Adapted quickly to changes in policies and procedures related to healthcare regulations.
  • Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
  • Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
  • Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
  • Performed prior authorization review of services requiring notification.
  • Facilitated workgroup meetings with medical personnel to find effective solutions to issues.
  • Minimized financial risk associated with denials or payment discrepancies through diligent validation of medical necessity prior to service provision.
  • Fostered a culture of continuous learning by actively participating in departmental meetings, trainings, and continuing education opportunities related to utilization review.
  • Assisted discharge planning efforts through prompt identification of medically stable patients who were ready for transition to alternate levels of care.
  • Ensured timely patient discharges by coordinating with healthcare teams, optimizing bed availability.
  • Improved patient outcomes by meticulously reviewing patient records to ensure appropriate care levels.
  • Collaborated with leadership to devise initiatives for improving nursing satisfaction, retention and morale.

Discharge Planner

Massachusetts General Hospital
05.2013 - 03.2015
  • Coordinated discharge plans ensuring timely transitions to post-acute care settings.
  • Collaborated with multidisciplinary teams to assess patient needs and resources.
  • Developed educational materials for patients and families regarding discharge procedures.
  • Monitored compliance with hospital policies and regulatory standards during discharges.
  • Facilitated communication between healthcare providers, patients, and families to improve outcomes.
  • Improved patient satisfaction by carefully evaluating their needs and developing personalized discharge plans.
  • Coordinated timely discharges by effectively communicating with physicians, nurses, social workers, and other relevant stakeholders.
  • Solved problems related to abrupt changes in discharge, coordinated updates and communicated discharge plans.
  • Facilitated smooth transfers between hospital departments, minimizing delays in patient care during transition periods.
  • Coordinated travel arrangements and contacted family with travel information.
  • Managed complex cases involving multiple medical issues or psychosocial challenges by utilizing critical thinking skills and professional expertise in discharge planning processes.
  • Managed caseload to satisfy multiple patients with diverse needs.
  • Facilitated family meetings to discuss patient care plans.
  • Participated in interdisciplinary care conferences to discuss patient care plans and referrals.

Education

Diploma - Nursing

New England Baptist Nursing School
Boston, MA
05-1983

Skills

  • Proficient in InterQual criteria


  • Detailed records assessment

  • Effective interpersonal communication


  • Coordinating discharge planning

  • Utilization management

  • Medicare


  • Teamwork and collaboration



  • Compassionate and caring
  • Excellent communication
  • Reliability
  • Critical thinking

  • Organizational skills

  • Adaptability and flexibility



  • Task prioritization
  • Interpersonal skills

Certification

  • Certified Interqual Instructor, Mass General Hospital - 09/10/2025

Timeline

Discharge Planner

Massachusetts General Hospital
05.2013 - 03.2015

Utilization Review Nurse Clinical Coordinator

Massachusetts General Hospital
03.2013 - Current

Diploma - Nursing

New England Baptist Nursing School

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