Deborah Stanutz
Marco Island,FL
Summary
Dedicated Registered Nurse with over 15 years of expertise in Utilization and Care Management, skilled in delivering education and managing resources to enhance healthcare efficiency. Proven ability to develop and implement Utilization Management processes and Resource Guides, contributing to improved patient care while preventing unnecessary medical services. Highly proficient in managing a substantial caseload within an interdisciplinary team, ensuring patient needs are met and care gaps effectively addressed. Strong clinical and communication skills, with a commitment to maintaining accurate documentation and patient confidentiality, complemented by CCM Certification.
Overview
22
22
years of professional experience
1
1
Certification
Work History
Case Management Clinical Coordinator
Humana Inc
02.2014 - Current
- Assisted team with devising and implementing clinical protocols for the new Medicare-Medicaid Initiative Alignment Plan (MMAI).
- Identified areas of opportunity for process improvements, leading efforts to implement changes that resulted in enhanced operational efficiency.
- Coordinate multidisciplinary team meetings to streamline patient treatment plans, improving communication and recommending appropriate resources and patient education to close gaps in care, and reduce readmissions.
- Developed training materials to strengthen clinical competencies and improve team performance.
- Built strong relationships with the care management teams for optimized care satisfaction.
- Updated staff with changes and new Humana initiatives under the MMAI Plan.
- Offer guidance and support to colleagues and team.
Utilization Review Coordinator/Team Lead
Humana Insurance Company
01.2006 - 02.2014
- Coordinated utilization review processes to ensure compliance with healthcare regulations.
- Developed and implemented training programs for staff on utilization management protocols.
- Advocated for patients' needs by facilitating communication between providers and insurance companies.
- Assisted leadership in setting annual objectives for the Utilization Review Department based on organizational priorities.
- Enhanced patient care quality by conducting thorough utilization reviews and coordinating with healthcare providers.
- Evaluated medical necessity criteria using evidence-based guidelines to ensure that services provided were both clinically appropriate and cost effective.
- Managed complex cases involving multiple medical conditions, coordinating care among various specialists while adhering to strict timelines for decision making.
- Served as a trusted resource for clinical staff seeking guidance on appropriate levels of care, alternate treatment options, or clarification on insurance coverage requirements.
- Reduced hospital readmissions by implementing effective discharge planning and ensuring appropriate post-acute care.
Care Management Associate
Humana Insurance Company
05.2004 - 01.2006
- Coordinated care plans to enhance patient outcomes and streamline communication among healthcare providers.
- Monitored patient progress, ensuring adherence to treatment protocols and timely follow-ups.
- Assisted in the development of process improvements for care management workflows and documentation accuracy.
- Educated patients on health management strategies, fostering independence and self-advocacy in their care journey.
- Coordinated post-discharge care by communicating with outpatient clinics, community resources, agencies and families around patients' transitional care.
- Evaluated the effectiveness of interventions through ongoing assessment, analysis, and adjustment of care plans.
Education
Associate of Science - Nursing Diploma
Bryn Mawr Hospital School of Nursing
Bryn Mawr, PABachelor of Science - Nursing
Spalding University
Louisville, KY06-2022
Skills
- Quality improvement
- Attention to detail
- Knowledge of Medicaid and Medicare programs
- Teamwork and collaboration
- Problem-solving abilities
- Reliability
- Critical thinking
- Organizational skills
- Excellent interpersonal and written communication
Affiliations
Certified Case Manager 2008-Current
Certification
- Nursing Board Examination 1982
- Florida Nursing Multistate License Current
- Illinois Nursing License Current
- CCM Certification 2018- Current
Timeline
Case Management Clinical Coordinator
Humana Inc
02.2014 - Current
Utilization Review Coordinator/Team Lead
Humana Insurance Company
01.2006 - 02.2014
Care Management Associate
Humana Insurance Company
05.2004 - 01.2006
Associate of Science - Nursing Diploma
Bryn Mawr Hospital School of Nursing
Bachelor of Science - Nursing
Spalding University