Dawn Chicoine
Marlborough,CT
Summary
Results-oriented Analytical Professional with robust technical knowledge and critical thinking skills, adept at navigating data-driven environments. Recognized for overcoming challenges with a positive attitude and consistently exceeding expectations. As a motivated Team Lead, demonstrate exceptional leadership and planning abilities to deliver high-quality products on tight schedules while fostering team development through proactive training. Dynamic Utilization Manager with a strong focus on coaching and mentoring teams to achieve performance excellence. Experienced in process improvement and regulatory compliance, driving successful outcomes through effective collaboration and customer-centric strategies.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Team Lead, Utilization Manager Nurse Consultant
Aetna, a CVS Health
Hartford, CT
12.2018 - Current
- Established clear team goals aligned with company objectives, tracking progress regularly.
- Delegated tasks appropriately according to individual skill sets.
- Collaborated with other departments to streamline processes and improve interdepartmental cooperation.
- Analyzed key performance indicators to identify effective strategies.
- Championed the adoption of new technologies to improve team productivity and service delivery.
- Trained new staff in relevant processes and procedures.
Utilization Review Nurse - Post Acute
ConnectiCare
Farmington, CT
04.2014 - 12.2018
- Served as a resource for staff on utilization review matters, enhancing decision-making and compliance.
- Collaborated with providers to gather clinical information, facilitating timely prior authorization determinations.
- Reviewed and updated utilization review criteria and guidelines to reflect current standards of practice.
- Facilitated secondary review of non-compliant cases, ensuring adherence to established criteria and improving review outcomes.
- Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
MDS Coordinator
National Healthcare Center
Marlborough, CT
09.2007 - 04.2014
- Compiled comprehensive reports on utilization review outcomes and quality indicators for management staff to inform decision-making.
- Ensured alignment of changes in plan of care with corresponding updates on MDS forms to enhance accuracy and compliance.
- Analyzed clinical data using statistical tools to identify informational trends.
- Reviewed and validated care plan reports while monitoring follow-up actions to identify and address systemic deficiencies.
- Reviewed clinical documentation to ensure accuracy of information reported on the MDS forms.
- Increased productivity and efficiency by regularly reevaluating processes and technologies.
Appeals Specialist
Qualidigm Quality Improvement Organization
Wethersfield, CT
12.2009 - 04.2014
- Demonstrated strong problem solving skills when resolving difficult customer service issues.
- Served as subject matter expert for non-standard coverage questions.
- Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
- Actively monitored progress on pending appeal cases ensuring timely completion of tasks associated with each claim dispute resolution.
- Reviewed documents for accuracy and completeness prior to processing appeals.
- Attended training sessions to learn about new laws or regulations affecting the appeals process.
Travel Nurse Telemetry
Nightingale Nursing Agency Midstate Medical Center
Meriden, Connecticut
12.2005 - 03.2006
- Monitored patient vital signs using telemetry equipment and identified irregularities.
- Administered medications and treatments according to physician orders and care plans.
- Documented patient conditions accurately in electronic health records systems.
- Assisted in emergency situations by implementing advanced life support protocols.
Acute Care Registered Nurse
Manchester Memorial Hospital
Manchester, CT
10.2005 - 12.2005
- Administered medications and treatments, ensuring adherence to physician orders and patient safety.
- Monitored patient vital signs, promptly reporting changes to healthcare team to facilitate timely interventions.
- Assisted in emergency medical situations by providing immediate care.
- Documented patient information in electronic health records, maintaining accuracy for effective care coordination.
Acute Care RN
Mercy Medical Center
Clinton, IA
10.2004 - 09.2005
- Assisted in emergency response situations, ensuring timely and effective care for patients.
- Conducted telemetry readings and interpreted data to support critical clinical decisions.
- Administered medications and treatments per physician orders.
- Managed intravenous therapy, performing IV starts, changes, and discontinuation to maintain patient comfort and treatment efficacy.
Registered Nurse, prenatal
Edgerton Women's Health
Davenport, Iowa
09.2003 - 12.2004
- Provided comprehensive patient care in women's health services.
- Educated patients on health practices and preventive care, enhancing their understanding of wellness.
- Collaborated with healthcare teams to develop individualized treatment plans, improving patient outcomes.
- Conducted thorough patient assessments to identify immediate medical needs and prioritize care effectively.
Education
Bachelor of Science - Nursing
Southern New Hampshire University
Manchester, NH03-2025
Associate degree - Nursing
Eastern Iowa Community College District
Clinton, IA05-2003
Skills
- Regulatory compliance
- Performance improvement
- Process improvement
- Customer focus
- Deadline management
- Talent acquisition
- Diversity initiatives
- Change leadership
- Team leadership
- Task delegation
- Staff training
- Coaching
- Customer focus
- Attention to detail
- Loss prevention
- Team leadership
References
Available upon request
Certification
- Registered Nurse - Connecticut and Iowa
Timeline
Team Lead, Utilization Manager Nurse Consultant
Aetna, a CVS Health
12.2018 - Current
Utilization Review Nurse - Post Acute
ConnectiCare
04.2014 - 12.2018
Appeals Specialist
Qualidigm Quality Improvement Organization
12.2009 - 04.2014
MDS Coordinator
National Healthcare Center
09.2007 - 04.2014
Travel Nurse Telemetry
Nightingale Nursing Agency Midstate Medical Center
12.2005 - 03.2006
Acute Care Registered Nurse
Manchester Memorial Hospital
10.2005 - 12.2005
Acute Care RN
Mercy Medical Center
10.2004 - 09.2005
Registered Nurse, prenatal
Edgerton Women's Health
09.2003 - 12.2004
Bachelor of Science - Nursing
Southern New Hampshire University
Associate degree - Nursing
Eastern Iowa Community College District