COURTNEY SMITH
Crescent,PA
Summary
Knowledgeable Senior Care Manager with proven expertise in overseeing utilization review processes to ensure compliance and efficiency. Coordinates with multidisciplinary teams, enhancing workflow and reducing unnecessary costs while maintaining high-quality standards. Demonstrated strong analytical and problem-solving skills, coupled with effective communication and leadership abilities.
Overview
2027
2027
years of professional experience
1
1
Certification
Work History
Senior Care Manager
Highmark
Pittsburgh, PA
2022 - Current
- Implemented quality improvement initiatives that streamlined workflows and increased operational efficiency.
- Monitored performance metrics to assess the effectiveness of utilization management initiatives.
- Increased compliance with regulatory requirements by monitoring adherence to guidelines and protocols within the utilization management department.
- Conducted regular evaluations of staff performance, providing constructive feedback and implementing appropriate interventions when necessary to improve overall team effectiveness.
- Enhanced team performance by providing training, guidance, and feedback to utilization management staff members.
- Supported leadership initiatives aimed at improving organizational performance related to health plan accreditation standards or contractual obligations with networks agreements.
Supplemental Nursing Support Staff
Heritage Valley Sewickley
Sewickley, PA
2022 - 2025
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Excellent communication skills, both verbal and written.
- Demonstrated respect, friendliness, and willingness to help wherever needed.
- Worked flexible hours across night, weekend, and holiday shifts.
Registered Nurse
Maxim Healthcare
Pittsburgh, PA
2020 - 2022
- Monitored and recorded patient condition, vital signs, progress and medication administration.
- Administered medications, tracked dosages and documented patient conditions.
- Treated patients suffering from seizure disorders.
- Prioritized nursing tasks and assignments and accurately reported patient status.
Care Manager, RN
Gateway Health Plan
Pittsburgh, PA
2017 - 2022
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
- Determined medical necessity and cost-effectiveness of services through utilization review processes.
- Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
- Referred cases to secondary review for failure to meet criteria.
- Managed and monitored onboarding process for nursing staff, encompassing new employee orientation and scheduling.
- Spearheaded additional support during rollout of new documentation system.
Clinical Nurse Supervisor
Heritage Valley Health System
Sewickley, PA
2011 - 2017
- Provided strong leadership and guidance to nurses.
- Established and maintained positive relationships with residents, physicians, hospital staff, patients and families.
- Collaborated with department managers to correct problems and improve services.
- Supervised daily nursing activities and general operations while delivering exceptional care and building solid nursing teams for Emergency Department with 25 beds.
- Delegated clinical and managerial responsibilities to staff.
- Maintained quality care systems, standards and HIPAA confidentiality.
- Conducted restraint audits according to organizational guidelines and generated reports for nursing leadership review and analysis.
- Supervised ancillary staff and nurses by scheduling shifts, delegating assignments and monitoring quality of care.
- Facilitated patient flow during emergency situations, directing evacuations, admissions and transfers.
Registered Nurse
Heritage Valley Health System
Sewickley, PA
2007 - 2011
- Monitored and managed various treatment and care interventions.
- Treated patients suffering from chronic and acute asthma, seizure disorders and pneumonia.
- Trained new RN hires and ancillary staff members to meet patient service goals, champion standards of care and improve patient overall satisfaction.
- Trained and mentored new RNs on best practices, hospital policies and standards of care.
- Prioritized nursing tasks and assignments and accurately reported patient status.
- Acted as patient advocate and implemented total patient care through team nursing process.
Graduate/Registered Nurse
Allegheny General Hospital
Pittsburgh, PA
2007 - 2007
- Monitored and managed various treatment and care interventions.
- Monitored and recorded patient condition, vital signs, recovery progress and medication side effects.
- Administered medications, tracked dosages and documented patient conditions.
- Prioritized nursing tasks and assignments and accurately reported patient status.
- Maintained personal and team compliance with medication administration standards and patient care best practices.
- Managed central, arterial, intravenous and PICC lines.
Clinical Technician
Sewickley Valley Hospital
Sewickley, PA
2005 - 2007
Nursing Assistant
UPMC Presbyterian Shadyside Hospital
Pittsburgh, PA
2005 - 2005
Nurses Aide
Country Care Manor
Fayette City, PA
2004 - 2005
Nurses Aide
Caring 4 Friends, INC
Koppel, PA
2004 - 2005
Secretary/File Clerk
Peterson Insurance Associates, INC
Rochester, PA
2000 - 2007
Education
Bachelor of Science - Nursing
Slippery Rock University
Slippery Rock, PA12-2012
Associates Degree - Nursing
Community College of Allegheny County
Pittsburgh, PA12-2006
Diploma -
Monaca Jr./Sr. High School
Monaca, PA06-2003
Skills
- High functioning in a stressful environment
- Nursing staff leadership
- Critical care and ED experience
- Care coordination
- Quality improvement
- Staff education
- Teamwork and collaboration
- Problem-solving
- Multitasking
Certification
Registered Nurse, RN
Timeline
Associates Degree - Nursing
Community College of Allegheny County
Diploma -
Monaca Jr./Sr. High School
Senior Care Manager
Highmark
2022 - Current
Supplemental Nursing Support Staff
Heritage Valley Sewickley
2022 - 2025
Registered Nurse
Maxim Healthcare
2020 - 2022
Care Manager, RN
Gateway Health Plan
2017 - 2022
Clinical Nurse Supervisor
Heritage Valley Health System
2011 - 2017
Registered Nurse
Heritage Valley Health System
2007 - 2011
Graduate/Registered Nurse
Allegheny General Hospital
2007 - 2007
Clinical Technician
Sewickley Valley Hospital
2005 - 2007
Nursing Assistant
UPMC Presbyterian Shadyside Hospital
2005 - 2005
Nurses Aide
Country Care Manor
2004 - 2005
Nurses Aide
Caring 4 Friends, INC
2004 - 2005
Secretary/File Clerk
Peterson Insurance Associates, INC
2000 - 2007
Bachelor of Science - Nursing
Slippery Rock University
Certifications
- Basic Life Support
- NIH Stroke Scale
- Advanced Burn Life Support