CAYLA FOSTER
Harlem,GA
Summary
Dynamic Director oversees every facet of production with strong project management and decision-making skills. Brings comprehensive knowledge of Utilization Review technical operations. Skilled at coordinating operation plans and a personnel resources to complete work under tight deadlines. Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Utilization Review Director
HCA Healthcare
Nashville, TN
08.2021 - Current
- Developed high-performing teams by providing mentorship, guidance, and opportunities for professional growth.
- Enhanced team collaboration through regular bi-weekly department meetings encouraging communication
- Established a culture of continuous improvement by fostering open communication channels and empowering employees to voice their ideas.
- Cultivated a positive work environment that fostered employee engagement, increased retention rates, and boosted overall team morale.
- Strengthened internal controls by reviewing existing policies and procedures, ensuring compliance with regulatory requirements.
- Implemented business strategies utilizing STAT assignments to integrate best practice workflows in daily assignments, increasing revenue, and effectively decreasing in write-offs for San Antonio Market.
- Streamlined workflows also with STAT assignment by identifying bottlenecks in existing systems and implementing appropriate solutions.
- Led change management initiatives to drive organizational transformation without compromising employee morale or productivity levels.
Utilization Review Manager
HCA Healthcare
Nashville, TN
03.2021 - 08.2021
- Increased staff efficiency with effective delegation, supervision, and performance evaluation of team members.
- Managed department budgets, allocating funds appropriately for staffing needs, training initiatives, and technology updates.
- Streamlined communication between interdisciplinary teams, fostering collaboration for improved patient outcomes.
- Collaborated with insurance companies to ensure proper reimbursement for services provided, maximizing revenue potential.
- Ensured consistent application of admission criteria among team members through ongoing education and feedback sessions.
- Spearheaded implementation of new software systems that streamlined workflow processes within the department leading to increased efficiencies in daily operations.
- Assisted in organizing and overseeing assignments to drive operational excellence.
- Successfully managed budgets and allocated resources to maximize productivity and profitability.
Utilization Review Nurse
HCA Healthcare
Nashville, TN
03.2018 - 08.2021
- 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.
- Fostered a culture of continuous learning by actively participating in departmental meetings, trainings, and continuing education opportunities related to utilization review.
- Minimized financial risk associated with denials or payment discrepancies through diligent validation of medical necessity prior to service provision.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Performed admission reviews based for medical necessity based upon InterQual specification.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Cross-trained existing employees to maximize team agility and performance.
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
- Drove operational efficiency through data-driven decision-making processes, leveraging analytics tools for informed strategy development.
- Assisted in organizing and overseeing assignments to drive operational excellence.
Methodist Healthcare Resource Nurse
Methodist Healthcare System
San Antonio, TX
02.2017 - 03.2018
- Served as an advocate for both patients and fellow staff members by addressing concerns or issues promptly and professionally.
- Provided clinical expertise during difficult medical situations, ensuring optimal patient outcomes through sound decision-making skills.
- Collaborated closely with interdisciplinary teams during care plan meetings, ensuring comprehensive approaches to patient care were developed and implemented effectively.
- Mentored new nursing staff, contributing to their professional growth and improved performance within the team.
- Enhanced interdisciplinary communication through effective collaboration with physicians, therapists, and other healthcare professionals.
- Led teams in driving successful patient outcomes by prioritizing standard of care and best practices.
- Collaborated with leadership to devise initiatives for improving nursing satisfaction, retention and morale.
Travel Nurse (Oncology/Telemetry/Med-Surg)
Healthtrust Workforce Solutions (Parallon)
San Antonio, TX
05.2016 - 02.2017
- Delivered high-quality patient care during emergency situations, remaining calm under pressure and effectively prioritizing tasks according to urgency.
- Demonstrated adaptability in rapidly adjusting to changing unit assignments, consistently maintaining high-quality care delivery across various clinical settings.
- Maintained excellent time management skills during periods of high patient turnover while consistently delivering compassionate and patient-centered care.
- Collaborated with interdisciplinary teams to develop impactful treatment plans.
- Promoted a positive work environment through mentorship, collaboration, and effective conflict resolution among team members.
- Served as a resource for colleagues seeking guidance on clinical best practices and procedures, fostering an atmosphere of continuous learning and professional development.
- Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
Travel Nurse (Telemetry/Med-Surg)
Aequor Healthcare Services
San Antonio, TX
10.2015 - 04.2016
- Promoted a positive work environment by actively participating in unit meetings and fostering teamwork among colleagues.
- Supported fellow nurses by sharing best practices in telemetry nursing, providing guidance on complex cases, and offering constructive feedback when needed.
- Demonstrated adaptability in adjusting to various clinical settings while traveling to different hospitals as a Travel Nurse Telemetry professional.
- Elevated quality of care through consistent adherence to evidence-based practices in telemetry nursing interventions.
- Streamlined communication among team members by providing clear, concise updates during shift handoffs and nursing huddles.
- Contributed to efficient unit operations by managing time effectively, prioritizing tasks based on urgency, and delegating responsibilities appropriately.
- Led teams in driving successful patient outcomes by prioritizing standard of care and best practices.
- Collaborated with leadership to devise initiatives for improving nursing satisfaction, retention and morale.
PCCU (Progressive Coronary Care Unit)
Caromont Regional Medical Center
Gastonia, NC
08.2014 - 09.2015
- Initiated appropriate interventions during life-threatening arrhythmias, preserving patient stability and preventing further complications.
- Provided emotional support for families during difficult times, helping them navigate challenging medical situations.
- Reduced readmission rates by providing thorough discharge education to patients and families.
- Collaborated with interdisciplinary team members for optimal patient care and treatment plans.
- Prioritized tasks efficiently under high-pressure circumstances ensuring timely completion of all responsibilities.
- Served as a preceptor for new nursing staff, contributing to their successful integration into the unit.
Med-Surg, RN (North Station)
Kings Mountain Hospital
Kings Mountain, NC
03.2012 - 08.2014
- Received employee of the month for Kings Mountain Hospital in March 2014
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Provided emotional support to patients during challenging times, fostering a sense of trust and rapport that contributed to better overall wellbeing.
- Managed patient caseloads effectively, ensuring timely interventions and thorough follow-ups to mitigate potential complications.
- Coordinated discharge planning efforts with social workers, case managers, and other multidisciplinary team members for smooth transitions posthospitalization.
- Streamlined documentation processes to ensure accurate record-keeping and compliance with regulatory standards.
- Aligned nursing goals with department objectives to enhance overall performance metrics within the healthcare facility.
Psychiatric, RN
Frye Regional Medical Center
Hickory, NC
08.2011 - 03.2012
- Administered medications accurately and safely, reducing medication errors and adverse reactions.
- Collaborated with interdisciplinary teams for comprehensive patient care plans, resulting in better health outcomes.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Provided emotional support to patients and their families.
- Monitored patient reactions to drugs and carefully documented findings.
Education
Bachelor of Science: RN-BSN -
Winston-Salem State University
Winston-Salem, NC12.2014
Associate of Science: Registered Nurse -
Gardner-Webb University
Boiling Springs, NC05.2011
High School Diploma -
Forestview High School
Gastonia, NC06.2009
Skills
- Team/Operations Management
- Creativity and Innovation
- Effective leader
- Complex Problem-Solving
- Effective/Excellent Communication
- Attention to Detail
- Multitasking Abilities
- Managing Operations and Efficiency
- MS Office (ie Excel, OneNote, Word, PowerPoint)
- Midas, Meditech, Meditech Expanse, PA Insight, ONBASE, eSAF, GHR
- Idea Development and Brainstorming
- Task Prioritization
Accomplishments
- Achieved HCA URS Targeted Goal of 87% Adjusted All Days Authorized for both my divisions 2023 and 2024 through effectively helping with staff organization and job operations.
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Proven successful Write-Off decrease in San Antonio Division.
Certification
- North Carolina Registered Nurse Multistate – Active
- HCA Leadership Program
- IQCER
Personal Information
Title: RN BSN
Timeline
Utilization Review Director
HCA Healthcare
08.2021 - Current
Utilization Review Manager
HCA Healthcare
03.2021 - 08.2021
Utilization Review Nurse
HCA Healthcare
03.2018 - 08.2021
Methodist Healthcare Resource Nurse
Methodist Healthcare System
02.2017 - 03.2018
Travel Nurse (Oncology/Telemetry/Med-Surg)
Healthtrust Workforce Solutions (Parallon)
05.2016 - 02.2017
Travel Nurse (Telemetry/Med-Surg)
Aequor Healthcare Services
10.2015 - 04.2016
PCCU (Progressive Coronary Care Unit)
Caromont Regional Medical Center
08.2014 - 09.2015
Med-Surg, RN (North Station)
Kings Mountain Hospital
03.2012 - 08.2014
Psychiatric, RN
Frye Regional Medical Center
08.2011 - 03.2012
Bachelor of Science: RN-BSN -
Winston-Salem State University
Associate of Science: Registered Nurse -
Gardner-Webb University
High School Diploma -
Forestview High School