Deborah Dour

Utilization Management:

• Maintained strict adherence to HIPAA regulations, safeguarding sensitive patient information throughout all aspects of the utilization review process.
• Collaborated with physicians to develop appropriate orders on utilization review findings that were both medically necessary and costeffective.
• Provided accurate documentation of all utilization review findings, ensuring a clear audit trail for future reference.
• Established strong working relationships with LTAC representatives, fostering open communication channels for efficient resolution of coverage issues or disputes related to medical necessity determinations.
• Performed admission reviews based for medical necessity based upon INTERQUAL specification.

Critical Access Hospital, Emergency Department

• Manage chronic, acute, or acute-on-chronic medical conditions with either single- or multi-organ dysfunction/failure
• Assist in life-saving procedures [Inserting/removing arterial lines, central venous lines, Swan-Ganz, chest tubes, and endotracheal tubes; assisting with bronchoscopy]
• Provide advanced life support Ventilators, BiPAP & CPAP, Left vs Right vs Bi-ventricular assist device (VAD), Cardioversion, Epicardial vs transcutaneous vs permanent pacer)]
• Administer & titrate continuous drug therapy [Vasopressors, Inotropes, Vasodilators, Analgesics, Anxiolytics, and Paralytics]
• Provide and advocate end-of-life care and support
• Collaborating with critical care team, ancillary team, consulting team, patients, and family members to provide on-going education and support
• Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities.

HSHS

• Test and validate changes in physician and nursing documentation in Meditech domains
• Educate, go-live and continual support of Computerized Physician Order Entry (CPOE), Bar Code Medication Administration (BCMA), Lab Scanning, and Smart Pump Auto-Programming as part of Joint Commission’s National Patient Safety Goals and CMS "Meaningful Use" initiatives
• Perform Gap Analysis of smart pump auto-programming current state and wireless scanners & swivel computer monitor arms
• Collaborate with clinical and administrative leaders to identify and implement a safer, higher quality patient care environment