Crystal Shumaker
Sherwood,AR
Summary
Seasoned healthcare executive with a proven track record at Arkansas Blue Cross Blue Shield, specializing in Utilization & Case Management and Strategic Leadership. Spearheaded a documentation platform overhaul, significantly enhancing efficiency and compliance. Known for fostering team diversity and driving major process improvements, my leadership has consistently improved operational outcomes and nurse morale.
Overview
24
24
years of professional experience
Work History
Director of Utilization Management
Arkansas Blue Cross Blue Shield
07.2022 - Current
- Led implementation of a new documentation platform, enhancing standardization, accuracy, and efficiency across utilization management
- Optimized clinical review workflows, reducing review volumes by refining edit and pend procedures, leading to a faster and more efficient approval process
- Improved turnaround times for case reviews, eliminating missed deadlines and ensuring compliance with regulatory standards
- Developed innovative staffing solutions, reducing reliance on external vendors by introducing strategic shift changes, improving nurse morale and operational efficiency
- Drove automation initiatives, integrating bots for record retrieval, allowing nurses to focus on high-value clinical decision-making rather than administrative tasks
Manager of Clinical Support
Arkansas Blue Cross Blue Shield
01.2015 - 07.2022
- Spearheaded team diversity and inclusion initiatives, fostering a high-trust culture with low turnover rates over nine years, even after a major staff reduction
- Increased monthly referrals from 1,500 to 3,700 by streamlining workflow efficiencies
- Implemented advanced technology solutions, reducing staff clicks and access points, enhancing productivity, and reducing administrative burden
- Optimized clinical strategies and reduced financial risks by integrating gaps in care and performance guarantees (PGs) into national account algorithms
- Led cross-training initiatives, expanding nurse expertise to cover multiple lines of business, improving service delivery across customer service and case management
- Served as Clinical Lead for HealthShare, enhancing clinical documentation and data integration
- National Speaker at the 2019 Blue Summit, presenting on the successful enhanced Gaps in Care program
Director of Home Health Services
North Metro Home Health
01.2013 - 12.2014
- Directed home health operations, ensuring compliance with state and federal regulations while enhancing patient care outcomes
Regional Case Manager
Arkansas Blue Cross Blue Shield
02.2011 - 12.2012
Assistant Director of Home Health Services
North Metro Home Health
01.2009 - 02.2011
Case Manager, Home Health Services
North Metro Home Health
12.2000 - 01.2009
Education
Master of Nursing Informatics -
American Sentinel University
Waterbury, CTBachelor of Nursing -
University of Arkansas for Medical Sciences
Little Rock, ARSkills
- Utilization & Case Management
- URAC Compliance & Regulatory Oversight
- Prior Authorization & Concurrent Review
- Clinical Workflow Optimization
- Risk Management & Quality Improvement
- Strategic Leadership & Change Management
- Automation & Process Improvement
- Healthcare Analytics & forecasting
Timeline
Director of Utilization Management
Arkansas Blue Cross Blue Shield
07.2022 - Current
Manager of Clinical Support
Arkansas Blue Cross Blue Shield
01.2015 - 07.2022
Director of Home Health Services
North Metro Home Health
01.2013 - 12.2014
Regional Case Manager
Arkansas Blue Cross Blue Shield
02.2011 - 12.2012
Assistant Director of Home Health Services
North Metro Home Health
01.2009 - 02.2011
Case Manager, Home Health Services
North Metro Home Health
12.2000 - 01.2009
Master of Nursing Informatics -
American Sentinel University
Bachelor of Nursing -
University of Arkansas for Medical Sciences
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