Hi, I’m
Crystal Shumaker
MSN, RN, CCM
Sherwood,AR
Summary
Innovative Nursing Leader with over 20 years of experience in clinical practice and healthcare informatics. Adept at leveraging technology to enhance patient care and streamline clinical workflows. Proven track record in utilization management, case management, process optimization, and leading interdisciplinary teams. Passionate about integrating AI solutions to reduce cognitive burdens in clinical documentation.
Overview
24
years of professional experience
2
Certifications
Work History
Arkansas Blue Cross Blue Shield
Director of Utilization Management
07.2022 - Current
Job overview
- Directed implementation of a new documentation platform, enhancing standardization, accuracy, and efficiency across utilization management and case management
- Optimized clinical review workflows by reducing review volumes 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
- Facilitated collaboration between teams by encouraging open communication channels between case management and utilization management departments
Arkansas Blue Cross Blue Shield
Manager of Clinical Support
01.2015 - 07.2022
Job overview
- 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
North Metro Home Health
Director of Home Health Services
01.2013 - 12.2014
Job overview
- Managed home health services, ensuring state and federal regulation adherence
- Oversaw and evaluated the performance of departments including nursing, aides, billing, and clerks to ensure quality
- Analyzed medical records to optimize healthcare services
- Coordinated effective communication between governing boards, medical staff, and department heads through consistent leadership meetings
- Established process improvements and maintained objective goals for operational efficiency
- Analyzed facility activities and data to support annual budget planning and optimize service utilization
- Engaged with medical and community groups to enhance public relations, coordinate activities, and promote health programs
- Monitored quality and outcomes as an OBQI and CQI member, implementing strategic planning for department improvements
- Developed and maintained agency policies to ensure regulatory compliance
- Designed training materials, improving employee satisfaction and onboarding experience
- Created new visit forms to enhance documentation compliance
- Managed and maintained insurance contracts and established provider relationships with insurance companies
Arkansas Blue Cross Blue Shield
Regional Case Manager
02.2011 - 12.2012
Job overview
- Managed caseloads efficiently, prioritizing high-risk cases while ensuring all patients received appropriate attention and support.
- Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
- Skilled at working independently and collaboratively in a team environment.
- Worked flexible hours across night, weekend, and holiday shifts.
- Excellent communication skills, both verbal and written.
- Self-motivated, with a strong sense of personal responsibility.
- Improved patient outcomes by developing and implementing comprehensive care plans tailored to individual needs.
- Conducted thorough assessments to identify gaps in care and develop targeted interventions for improvement.
- Served as a liaison between patients and various support services such as financial assistance programs, community resources, and mental health counseling to ensure holistic care was provided.
North Metro Medical Center
Assistant Home Health Director
01.2009 - 02.2011
Job overview
- Established performance goals for employees and provided feedback on methods for reaching those milestones.
- Managed a team of healthcare professionals, ensuring efficient scheduling and high-quality patient care.
- Facilitated interdisciplinary meetings to discuss individual patients'' needs, develop comprehensive care plans, and coordinate services across multiple providers.
- Increased patient referrals by fostering strong relationships with community partners, hospitals, and physicians.
- Developed and implemented training programs for staff to enhance their knowledge and skills in home health management.
- Reduced staff turnover by cultivating a supportive work environment, providing regular feedback, and offering opportunities for professional development.
- Ensured compliance with all state and federal regulations through diligent documentation and thorough audits of home health services.
- Recruited, hired and trained staff, providing direct supervision, ongoing staff development and continuing education to employees.
North Metro Medical Center
RN Case Manager
12.2000 - 01.2009
Job overview
- Educated patients on disease management and self-care techniques, promoting lifestyle changes for improved health..
- Managed complex cases of critically ill patients, ensuring optimal treatment plans were executed effectively.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Improved patient outcomes by providing high-quality nursing care and implementing evidence-based practices.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Assessed patient conditions promptly upon admission to determine appropriate interventions and prioritize care needs.
- Coordinated discharge planning efforts with social workers, case managers, and other multidisciplinary team members for smooth transitions post hospitalization.
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- As needed pool nurse for hospital in Emergency Room, medical surgical, psychiatric, and rehabilitation.units.
Education
American Sentinel UniversityWaterbury, CT
Master of Nursing Informatics
University of Arkansas For Medical SciencesLittle Rock, AR
Bachelor of Nursing
Skills
Utilization and Case Management
Certification
Registered Nurse (RN) License, Active, 2000
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 Home Health Director
North Metro Medical Center
01.2009 - 02.2011
RN Case Manager
North Metro Medical Center
12.2000 - 01.2009
University of Arkansas For Medical Sciences
Bachelor of Nursing
5 2000
American Sentinel University
Master of Nursing Informatics
6 2021
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