Barbara M. Alexander
St. Augustine,FL
Summary
Dedicated healthcare professional seeking the position of Utilization Management Manager to leverage my experience in utilization review, and team leadership within a collaborative, patient-focused environment. My goal is to optimize clinical resource utilization while ensuring exceptional patient care and outcomes
Overview
20
20
years of professional experience
1
1
Certification
Work History
RN Utilization Management Team Lead
Flagler Hospital
04.2024 - Current
- Lead a team of utilization management professionals in an acute care hospital, ensuring compliance with insurance regulations, clinical protocols, and hospital policies
- Oversee and perform clinical reviews to determine the appropriateness of continued patient care, ensuring optimal resource utilization while maintaining patient safety
- Facilitate communication between physicians, insurance providers, and hospital staff to streamline patient care plans and ensure adherence to utilization guidelines
- Develop strategies for improving efficiency in the utilization management process, reducing delays, and improving overall patient outcomes
- Mentor and train team members, fostering a collaborative work environment that emphasizes quality care and continuous improvement
Utilization Management Nurse
Flagler Hospital
02.2021 - Current
- Managed case load for acute care patients, conducting clinical admission and concurrent reviews to assess patient needs and ensure appropriate care levels
- Communicated with insurance providers, physicians, nursing staff, and interdisciplinary teams to ensure seamless patient care transitions
- Utilized evidence-based clinical criteria to determine the necessity of continued hospitalization and provided alternative care options when appropriate
- Documented clinical findings and interventions in accordance with hospital and regulatory requirements
RN Surgical Intensive Care Unit
Flagler Hospital
10.2019 - 02.2021
- Delivered advanced nursing care to critically ill patients, including those in the COVID-19 unit, with a focus on intensive monitoring and intervention
- Assessed and adjusted patient care plans to meet evolving clinical needs, including ventilator support, medication administration, and post-surgical recovery
- Collaborated with the interdisciplinary team to optimize care delivery and improve patient outcomes, ensuring timely communication with family members and addressing patient/family concerns
RN Weekend Manager
Vitas Healthcare
08.2019 - 01.2021
- Managed a caseload of approximately 500 hospice patients and families over the weekend, ensuring continuity of care and addressing urgent needs
- Led the scheduling and delegation of responsibilities for weekend staff, ensuring appropriate coverage and quality care for all patients
- Collaborated with multidisciplinary teams to address clinical issues, patient needs, and logistical challenges, enhancing patient satisfaction and care outcomes
- Oversaw discharge planning, new admissions, and care transitions from acute settings to home or other facilities, ensuring smooth operations and minimal disruptions
RN Renal Care Unit (7th Floor)
Flagler Hospital
05.2011 - 11.2019
- Provided specialized care for patients with renal conditions, including dialysis support and chronic disease management
- Collaborated with nephrologists, dietitians, and other specialists to ensure comprehensive care plans tailored to individual patient needs
- Managed complex patient assessments and assisted in the education of patients and families on lifestyle modifications and disease management strategies
Vitas Hospice Case Manager
Vitas Healthcare
10.2014 - 08.2019
- Managed a caseload of 15 to 20 hospice patients, providing comprehensive care in collaboration with a multidisciplinary team
- Conducted comprehensive patient assessments, including physical, psychological, and spiritual needs, and developed individualized care plans
- Ensured compliance with Medicare guidelines for care planning, visit frequency, and documentation while fostering a compassionate approach to end-of-life care
Licensed Practical Nurse
Samantha Wilson Care Center
08.2005 - 01.2010
- Provided direct nursing care under the supervision of a registered nurse, including medication administration, wound care, and patient monitoring
- Participated in patient assessments, care planning, and evaluations to ensure high-quality patient outcomes
- Assisted with the implementation of physician orders, and contributed to a collaborative team environment focused on patient-centered care
Education
Bachelor of Science - Nursing
Western Governors University
Salt Lake City, UT01-2023
Skills
Utilization Management & Clinical Review
Team Leadership & Staff Development
Patient Advocacy & Care Coordination
Regulatory Compliance & Documentation
Critical Thinking & Problem Solving
Patient Education & Communication
Certification
- Certified Case Manager 2022
Timeline
RN Utilization Management Team Lead
Flagler Hospital
04.2024 - Current
Utilization Management Nurse
Flagler Hospital
02.2021 - Current
RN Surgical Intensive Care Unit
Flagler Hospital
10.2019 - 02.2021
RN Weekend Manager
Vitas Healthcare
08.2019 - 01.2021
Vitas Hospice Case Manager
Vitas Healthcare
10.2014 - 08.2019
RN Renal Care Unit (7th Floor)
Flagler Hospital
05.2011 - 11.2019
Licensed Practical Nurse
Samantha Wilson Care Center
08.2005 - 01.2010
Bachelor of Science - Nursing
Western Governors University
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