Diane Hendry
Bethlehem,GA
Overview
48
48
years of professional experience
1
1
Certification
Work History
Utilization Review Manager
Emory University Hospital
01.2021 - Current
- Responsible for the direct oversight of the daily operations of the Utilization Review department
- Ensures the departmental day to day operations is successful by creating schedules, arranging coverage, and dividing work as necessary
- Ensure work is completed in a timely manner to ensure compliance with regulatory requirements
- Ensure that the team adheres to established policies and procedures
- Responsible for coaching, developing, training, and performance management process for employees
- Monitor LOS, avoidable days, read missions, denials, and address areas for improvement
- Collaborates with Leadership, Medical Directors, and Interdisciplinary teams
Utilization Review Analyst/Preceptor
Emory University Hospital
01.2014 - 01.2021
- Reviewed the OR schedule 48 hours prior to the scheduled surgery to ensure an authorization had been obtained and the admit status was correct
- Collaborated with the Precertification Team to ensure pended authorizations were obtained or cases were rescheduled
- Collaborated with the Precertification Team, Utilization Review Directors, Medical Director, physicians and CFO to improve the precertification process
- Educated the physician's Schedulers and the Precertification Team to utilize Medicare's Inpatient Only List
- Collaborated with the Precertification Manager and supervisors to improve the Precertification Team's documentation
- Increased the efficiency of the work flow process for the Utilization Review Department, as well as other departments by improving the Precertification Team's documentation
- Established Best Utilization Practices for the Precertification Process
- Piloted the Denial process and wrote the process
- Maintained a monthly spread sheet to show cost savings captured through the utilization review nurse's intervention
- Monthly cost savings averaged 290,000 to 750,000
- Performs medical reviews for all insurances and self-pays and applies criteria
- Piloted the Work from Home Program, supervised the staff of 7 employees and maintained the schedule
Case Manager
Rockdale Medical Center
01.2012 - Current
- Performs medical reviews for Medicare, Medicaid, Commercial Insurances, and Self Pay
- Utilizes InterQual guidelines and MCG guidelines
- Assists the social worker with discharge planning
- Refers appropriate cases to the Medical Director
- Stroke Team member
- Participated in the Stroke certification
Clinical UM RN Preceptor/Leadership Role
Emory University Orthopedic and Spine Hospital
01.2015 - 01.2018
- Lead Daily Rounds
- Attend weekly Leadership meetings
- Attend monthly physician meetings and educate the physicians on current utilization processes
- Perform utilization reviews on all admissions
- Assist the social workers with insurance issues
- Review the OR schedule 24 hours prior to admission to ensure an authorization has been obtained and the admit status is correct
- Collaborate with the Precertification Team to ensure pended authorizations are obtained or cases are rescheduled
- Maintain a monthly spread sheet to show the cost savings captured through the utilization review nurse's intervention
- Performed utilization reviews daily
- Apply Interqual and MCG guidelines
- Referred appropriate cases to the medical directors
- Complied with Medicare regulations for IM and Moon letters
- Train new employees
- Educate the staff as needed
- Wrote daily work flow process
- Maintain the training book
RAC Nurse Auditor
INVENTIV MEDICAL MANAGEMENT
01.2012 - 01.2013
- Reviewed the hospital medical records of Medicare inpatient admissions nationwide to determine the appropriateness of the admission status based on medical necessity
- Made a determination of the appropriateness of inpatient status versus observation status
- Provided a letter of determination to the facilities
Case Manager/Discharge Planner
CLEARVIEW REGIONAL
01.2010 - 01.2012
- Performed medical reviews for all insurances and self pay
- Appealed denials
- Arranged all discharge planning services
- Utilized InterQual guidelines
- Referred appropriate cases to the Medical Director
- Attended daily rounds
Case Manager/Discharge Planner
GWINNETT MEDICAL CENTER
01.2007 - 01.2011
- Performed medical reviews for Medicare, Medicaid, Self Pay, and Commercial Insurances
- Collaborated with the social workers to arrange nursing home placement, rehabilitation placement, and to assist uninsured patients with discharge needs
- Set up home health care services and durable medical equipment
- Utilized InterQual guidelines
- Referred appropriate cases to the Medical Director
- Attended daily rounds
- Follow up post discharge calls to patients
Onsite Inpatient Case Manager
CIGNA
01.1997 - 01.2007
- Performed onsite reviews
- Utilized MCG guidelines
- Assessed for appropriate level of care
- Coordinated discharge planning needs
- Referred appropriate cases to the Medical Director
- Attended Ground Rounds daily
- Referred cases to Case Management
- Attended meetings with contracted providers
Case Manager
Blue Cross of Georgia
, GA
01.1996 - 01.1997
- Coordinated discharge needs with members and their healthcare providers
- Followed members progress and needs
- Followed services for medical necessity
Case Manager
INTRACORP
01.1988 - 01.1995
- Coordinated discharge needs with members and their healthcare providers
- Contacted members/physicians/vendors to assess the member's progress and needs
- Followed services for medical necessity
- Supervised the Field Care Managers
Obstetrical High Risk Nurse
INTRACORP
01.1990 - 01.1991
- Assisted in piloting in the OB High Risk program
- Performed telephonic reviews with the members and their physicians
- Referred cases to Case Management
- Supervised a staff of eight employees
- Implemented training guidelines
- Conducted audits using Corporate Protocols
Primary Care Nurse/Obstetrical/GYN Unit
GLEN COVE COMMUNITY HOSPITAL, N.Y.
01.1986 - 01.1988
- Responsible for the total care of 10-20 patients
- Rotated as Charge Nurse
- Oriented new employees
Primary Care Nurse/Medical Surgical Unit
MERCY HOSPITAL, N.Y.
01.1982 - 01.1985
- Responsible for the total care of 10-20 patients
Primary Care Nurse/Medical Surgical/Orthopedic
HEMPSTEAD GENERAL HOSPITAL, N.Y.
01.1982 - 01.1985
- Responsible for the care of 10-18 patients
- Rotated as Charge Nurse
- Preceptor for new employees and University students during their clinical rotation
- Member of the Policy and Procedure Committee
LPN/Private Duty Nursing
MEDICAL PERSONNEL POOL
01.1976 - 01.1978
Education
BSN -
Molloy College
01.1982
LPN -
Board of Cooperative Education
01.1976
Affiliations
- Emory Care Coordination Educational Committee, 2015-Present
- Emory Diversity Committee and Steering Committee, 2016-2017
Certification
ACM, May 2015-Present
Timeline
Utilization Review Manager
Emory University Hospital
01.2021 - Current
Clinical UM RN Preceptor/Leadership Role
Emory University Orthopedic and Spine Hospital
01.2015 - 01.2018
Utilization Review Analyst/Preceptor
Emory University Hospital
01.2014 - 01.2021
Case Manager
Rockdale Medical Center
01.2012 - Current
RAC Nurse Auditor
INVENTIV MEDICAL MANAGEMENT
01.2012 - 01.2013
Case Manager/Discharge Planner
CLEARVIEW REGIONAL
01.2010 - 01.2012
Case Manager/Discharge Planner
GWINNETT MEDICAL CENTER
01.2007 - 01.2011
Onsite Inpatient Case Manager
CIGNA
01.1997 - 01.2007
Case Manager
Blue Cross of Georgia
01.1996 - 01.1997
Obstetrical High Risk Nurse
INTRACORP
01.1990 - 01.1991
Case Manager
INTRACORP
01.1988 - 01.1995
Primary Care Nurse/Obstetrical/GYN Unit
GLEN COVE COMMUNITY HOSPITAL, N.Y.
01.1986 - 01.1988
Primary Care Nurse/Medical Surgical Unit
MERCY HOSPITAL, N.Y.
01.1982 - 01.1985
Primary Care Nurse/Medical Surgical/Orthopedic
HEMPSTEAD GENERAL HOSPITAL, N.Y.
01.1982 - 01.1985
LPN/Private Duty Nursing
MEDICAL PERSONNEL POOL
01.1976 - 01.1978
BSN -
Molloy College
LPN -
Board of Cooperative Education
ACM, May 2015-Present