Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Charlotte Etienne, RN, CMCN

Dayton,OH

Summary

Utilization Management Nurse Manager with extensive experience in utilization management and direct patient care. Leads a team of 28 nurses, ensuring compliance with federal and state regulations. Adept in developing resource tools, standard operating procedures, performance management, optimizing productivity, and quality team performance.

Overview

11
11
years of professional experience
1
1
Certification

Work History

Utilization Management Manager

CareSource
01.2023 - Current
  • Conducted comprehensive audits of departmental operations to identify areas for improvement or potential risks related to non-compliance with state and federal regulations.
  • Maximized efficiency of case reviews through the development and implementation of standardized review procedures and resource tools.
  • Conducted regular evaluations of staff performance, providing constructive feedback and implementing appropriate interventions when necessary to improve overall team effectiveness.
  • Played a key role in the development and implementation of departmental policies and procedures aimed at maintaining high-quality care standards while adhering to regulatory guidelines within the scope of utilization management activities.

Utilization Management Team Lead

CareSource
10.2020 - 01.2023
  • Trained new team members by relaying information on company procedures and safety requirements.
  • Promoted a positive work environment by fostering teamwork, open communication, and employee recognition initiatives.
  • Served as a role model for the team by demonstrating commitment to excellence, professionalism, and adherence to company values at all times.
  • Coached team members in techniques necessary to complete job tasks.
  • Conducted regular progress reviews with individual team members to identify areas for improvement and provide guidance on career development opportunities.

Utilization Review Nurse

CareSource
09.2013 - 10.2020
  • 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.
  • Evaluated medical guidelines and benefit coverage to determine the appropriateness of services.

Education

Associate of Science - Nursing

Sinclair Community College
Dayton, OH
05.2003

Skills

  • Proficient in Milliman (MCG) evidence-based guidelines and ASAM criteria
  • Experienced in the NCQA accreditation process
  • Subject matter expert in Medicaid, Medicare, and Marketplace health plans
  • Performance Management
  • Utilization review for behavioral and physical health: prior authorizations, concurrent, inpatient, retrospective, outpatient, residential, and ABA reviews

Certification

Multi-state compact nursing license

Certification in Managed Care Nursing (CMCN) since 2016


Timeline

Utilization Management Manager

CareSource
01.2023 - Current

Utilization Management Team Lead

CareSource
10.2020 - 01.2023

Utilization Review Nurse

CareSource
09.2013 - 10.2020

Associate of Science - Nursing

Sinclair Community College

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Charlotte Etienne, RN, CMCN