Christie Golladay
Summary
Seasoned nursing professional offering proven clinical knowledge, natural interpersonal strengths and technical abilities. Knowledgeable about EMR charting, critical care and floor care areas and interdisciplinary collaboration focused on optimizing patient care and support. Quality-focused and efficiency-driven leader.
Love to continue to learn and advance all knowledge bases.
Currently a remote Utilization Management RN - also covering teaching / education and Denials Management.
My passion is teaching and educating.
Overview
29
29
years of professional experience
Work History
Registered Nurse
Wayne UNC Health
03.2010 - Current
- Served as a liaison between healthcare providers, insurance companies, and patients for efficient resolution of coverage issues or denials following a utilization review assessment.
- Promoted interdepartmental collaboration to streamline workflow processes, resulting in improved efficiency and patient outcomes.
- Collaborated with physicians to develop appropriate care plans based on utilization review findings that were both medically necessary and costeffective.
- Improved patient satisfaction by conducting thorough utilization reviews and ensuring appropriate care plans were in place.
- Expedited discharge planning processes through timely completion of utilization reviews that identified necessary services, supports, or referrals postdischarge.
- Maintained strict adherence to HIPAA regulations, safeguarding sensitive patient information throughout all aspects of the utilization review process.
- Increased staff knowledge and competency with continuous professional development opportunities related to evolving industry standards and trends in the field of medical necessity evaluations.
- Provided accurate documentation of all utilization review findings, ensuring a clear audit trail for future reference or analysis.
- Enhanced the efficiency of the utilization review process by collaborating with interdisciplinary teams and streamlining communication channels.
- Optimized resource allocation within the healthcare facility by accurately reviewing cases for level-of-care determinations according to established criteria sets.
- Collaborated with financial counselors to ensure accurate billing practices based on clinical documentation from utilization reviews.
- Assisted in maintaining regulatory compliance by staying up-to-date on Medicare, Medicaid, and commercial insurance requirements for utilization review activities.
- Strengthened quality improvement initiatives through regular audits of utilization review processes, identifying areas for improvement, and implementing corrective actions.
- Reduced hospital readmissions with proactive identification of high-risk patients and implementation of targeted interventions.
- Performed prior authorization review of services requiring notification.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Performed admission reviews based for medical necessity based upon all appropriate guidelines.
- Collaborated with billing team to address issues, resulting in fewer denials and increased revenue.
RN Floor Nurse
Johnston Health
02.1995 - 03.2010
- Utilize EPIC to document nursing assessments, treatments, medications and discharge instructions.
- Provided effective patient education, ensuring understanding of medical conditions and treatment protocols for better self-management.
- Ensured accuracy in patient records by meticulously documenting assessments, interventions, and outcomes, ultimately contributing to better-informed decision making by healthcare providers.
- Promoted a safe environment by consistently adhering to infection control policies and procedures.
- Collaborated with healthcare team members to assess, implement and evaluate nursing care plans.
- Managed critical situations calmly and efficiently, providing guidance to the nursing team during emergencies.
- Served as an approachable leader who consistently addressed concerns raised by both nursing staff and families regarding patient care issues or operational challenges within the unit effectively resolving them promptly whenever possible.
- Worked in the Float Pool - covering all Critical Care areas; Some specialty outpatient areas, as well as Medical and Surgical floors.
- Part - time coverage as the hospital Clinical Administrator as needed.
Education
Associate of Applied Science - Nursing
Southeastern Community College
Whiteville NC05.1993
Skills
- Strong Clinical Judgment
- Patient Assessment
- Documentation and Charting
- Clinical judgment
- Patient education and counseling
- Patient and family advocacy
- Patient Management
- Family Education
- Critical Care
- EMR Systems
- Complex Problem-Solving
- Maintaining privacy
- EMR / EHR
- High level of autonomy
- Emergency Care
- Microsoft Office
Timeline
Registered Nurse
Wayne UNC Health
03.2010 - Current
RN Floor Nurse
Johnston Health
02.1995 - 03.2010
Associate of Applied Science - Nursing
Southeastern Community College
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