Diane Thornton
Fernandina Beach,FL
Summary
Dynamic and results-oriented Registered Nurse with 21 years of experience seeking a management role. Demonstrated success across multiple industries, showcasing strong interpersonal, problem-solving, and analytical skills. Proficient in operations, strategy, and finance, adept at identifying opportunities for improvement and implementing impactful solutions. Skilled in utilizing quantitative analysis tools to investigate issues and develop tailored strategies. Known for presenting complex information in a clear and concise manner to facilitate efficient decision-making. Collaborative and strategic thinker dedicated to optimizing costs, processes, and resources for sustainable business growth. Produced detailed reports and ensured data accuracy for informed decision-making at the executive level. Contributed to cross-functional projects, providing valuable support to various departments.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Legal Nurse Consultant/Medical Records Director
Bush and Bush Law Firm
Dallas , TX
2023.11 - Current
- Improved patient care quality by implementing new clinical policies and procedures.
- Streamlined healthcare processes for increased efficiency and better patient outcomes.
- Developed strategic plans to achieve organizational goals and ensure long-term success in the medical field.
- Managed multidisciplinary teams, fostering collaboration between various healthcare professionals for optimal patient care.
- Enhanced operational performance by identifying areas of improvement and implementing change management strategies.
- Implemented innovative technologies to streamline workflows and improve overall patient experience.
- Mentored physicians and other medical staff, facilitating professional development through training programs.
- Conducted ongoing evaluations of medical practices, ensuring adherence to evidence-based guidelines and best practices.
- Optimized resource allocation by analyzing departmental budgets and reallocating funds where necessary for maximum impact on patient care.
- Established partnerships with external organizations, promoting collaboration on shared health initiatives.
- Led quality improvement initiatives resulting in enhanced clinical service delivery across departments.
- Championed a culture of continuous learning within the organization, encouraging staff to pursue ongoing education opportunities relevant to their roles.
- Proved successful working within tight deadlines and a fast-paced environment.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
Senior Clinical Advisory Consultant
Optum Advisory Services
2022.11 - 2023.08
- Delivered outstanding service to clients to maintain and extend relationship for future business opportunities.
- Analyzed problematic areas to provide recommendations and solutions.
- Liaised with customers, management, and sales team to better understand customer needs and recommend appropriate solutions.
- Managed multiple deadlines across several businesses to meet dynamic needs of multiple clients.
- Created and developed detailed work plans to meet business priorities and deadlines.
- Supported clients with business analysis, documentation, and data modeling.
- Collaborated with teams to define, strategize, and implement marketing and web strategies.
- Aligned closely with business owners and employees to gather information and gain operational insight.
- Integrated technology and business operations to identify targeted solutions to customer issues.
- Onboarded and managed new client accounts to boost retention rates.
- Implemented practices and procedures to reduce expenditures and increase savings.
- Created monthly forecast templates and resource management allocations for approved projects.
- Renegotiated outsourcing contracts to save considerable costs.
- Evaluated current processes to develop improvement plans.
Manager, Policy
UnitedHealthcare Clinical Services
2022.01 - 2022.11
- Research of CMS coverage policy, manuals, and requirements
- Interpretation of rules and guidelines for claims payment
- Work with multidisciplinary groups to develop coding to support accurate billing scenarios
- Work directly with implementation teams to implement policy appropriately in claim systems to allow accurate coverage decisions
- Address policy questions from designated groups within
- UHG
- Responsibility for policy updates at least annually or more frequently as rules change or coding requires updating
- Determine impact of policy in regard to FTE or operational costs
- Manage team of 6 to meet turnaround times or metrics established
- Provider guidance and leadership
- Enhanced Routing
- UNET
- Coding
- Milliman
- MS Office Programs
- Managed and motivated employees to be productive and engaged in work.
- Accomplished multiple tasks within established timeframes.
- Maintained professional, organized, and safe environment for employees and patrons.
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
- Monitored and analyzed business performance to identify areas of improvement and make necessary adjustments.
- Planned and budgeted accurately to provide business with resources needed to operate smoothly.
Clinical Manager Fraud, Waste, Abuse and Error
Optum
2017.10 - 2022.01
- Manage and direct activities for a team of 22 to make sure that they keep production schedules within acceptable timeframes
- This includes multiple levels of staff in multiple departments across several business units
- Review, create and/or maintain job aids and review guidelines to ensure that they are up to date and are operationally efficient
- Projects: Generating AI with clinical logic and deciphering medical records and Clinical decision automation (CDA), Auto D
- CLI NLP O360 tool, creating Quality test for Employer & Individual
- Communicated effectively with staff members, physicians, and patients, employing active listening and interpersonal skills.
- Identified opportunities to improve clinical practices, devised strategies and implemented plans to increase patient care standards and enhance operational procedures.
- Enhanced routing and work prioritization within PICTS, reviewing training materials for Coding Academy (non- clinical to clinical), W&E Education initiative by creating education for team (internal training)
- Track performance of each individual on my team by using internal tools to ensure that my team is remaining productive
- Provide coaching and feedback regularly to all members of my team
- Train and educate internal stakeholders on relevant policies and procedures
- Communicate and coordinate with internal and external partners to ensure compliance with contractual and regulatory requirements.
Registered Nurse Tricare Supervisor
United Healthcare Group
2016.06 - 2017.10
- Prior Authorization team of 18 registered nurses in their day to day operation to ensure we were meeting turnaround times and overall program delivery
- Managing and training of staff, development of projects, collaboration with other departments such as
- Community and State, Medicare and Medicaid and daily management of the Prior Authorization utilization management program
- Additional duties included regulatory adherence with
- NCQA, TRO-W, and Tricare.
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Led successful team comprised of RNs, LPNs, and ancillary staff.
- Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.
Registered Nurse Transplant Case Manager
Optum
2011.12 - 2016.06
- Reviewed members' benefit plans and made coveragedeterminations for transplants to make sure claimswere paid
- Primary liaison between clients, account managers andproviders
- Initial contact with members and requesting facility toprovide accurate transplant benefits anddetermination
- Worked with members regarding claims, clarification ofbenefits and provided assistance with travel andlodging accommodations
- Collaborated with providers doing prior authorizationsfor members according to state laws and contracts
- Maintaining a specialized care plan with members priorto transplant and up to one year post-transplant
- Utilized UNET, ICUE (HSR and CPM) and Milliman Care
- Guidelines (MCG) to document telephonic interactionsbetween members, providers, and facilities.
Registered Nurse
Winnie Palmer Hospital For Women
2010.02 - 2011.12
- Performed arterial cut-downs, inserted central linesand inserted endotracheal tubes as part of traumateam
- Audited charts and reviewed clinical documents toverify accuracy
- Taught patients how to improve lifestyle choices,dramatically reducing chance of symptomreoccurrence
- Secured controlled narcotics and distributedmedication on schedule to meet patient needs andminimize misuse opportunities
- Managed care from admission to discharge.
Nurse
Advent Health, formerly Florida Hospital
2003.06 - 2010.02
- Assisted physician during delivery, examination andsurgical procedures by anticipating needs, encouragingpatient and attending to baby after birth
- Coordinated care of low and high-risk laboring womenof childbearing age and immediate stabilization ofnewborn following delivery
- Responded to emergency situations such as pre-eclampsia, early labor and fetal distress
- Worked closely with doctors and midwives in coachingpregnant women through childbirth and post-natalrecovery
- Coached new mothers with breastfeeding techniques,postpartum self-care and infant care to promote easiertransition into motherhood
- Supported physicians in both planned and emergency
- Cesarean section procedures.
Education
Bachelor of Science - Nursing
Florida Hospital College ofHealth Sciences
Orlando, Florida05.2009
Associate of Science - Nursing
Florida Hospital College Of Health Sciences
Orlando, Florida05.2003
Skills
- Registered Nurse (21 years)
- Operational Procedures
- Project Analysis
- Corrective Actions
- Change Management
- Analytical Thinking
- Web Applications
- Clinical Instruction
- Active Listening
- Case Management
- Staff Development
- Improving Clinical Quality Outcomes
- Utilization Management
Timeline
Legal Nurse Consultant/Medical Records Director
Bush and Bush Law Firm
2023.11 - Current
Senior Clinical Advisory Consultant
Optum Advisory Services
2022.11 - 2023.08
Manager, Policy
UnitedHealthcare Clinical Services
2022.01 - 2022.11
Clinical Manager Fraud, Waste, Abuse and Error
Optum
2017.10 - 2022.01
Registered Nurse Tricare Supervisor
United Healthcare Group
2016.06 - 2017.10
Registered Nurse Transplant Case Manager
Optum
2011.12 - 2016.06
Registered Nurse
Winnie Palmer Hospital For Women
2010.02 - 2011.12
Nurse
Advent Health, formerly Florida Hospital
2003.06 - 2010.02
Bachelor of Science - Nursing
Florida Hospital College ofHealth Sciences
Associate of Science - Nursing
Florida Hospital College Of Health Sciences
Clinical Nursing 8 years Managerial Leadership Team Management Program Management Project Management Certified Coach Case Management Appeals Review Prior Authorization Tricare Military and Veterans ICUE Citrix Cirrus PICTS Clinical Decision Automation(CDA) Auto D
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