Dorothy Wells
Corinth,United States
Summary
Senior Clinical Quality RN with over a decade of utilization management experience, specializing in medical necessity review, regulatory compliance, and applying criteria for evidence-based decisions. Provides senior level representation of utilization management cases during client-facing audits.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Senior Clinical Quality RN
United Healthcare
Dallas, TX
01.2025 - Current
- Conduct comprehensive utilization management chart reviews to ensure cases are processed according to established procedures.
- Identify potential process gaps and partner with leadership to implement remediation.
- Present utilization management cases to an external consultant during formal client audits and provide additional information and follow-up as indicated.
INPATIENT CARE MANAGER
Optum, UnitedHealth Group
Richardson, TX
06.2012 - Current
- Extensive experience in determining the medical appropriateness of inpatient level of care following the evaluation of medical guidelines and benefit determination.
- Collaborate with the Medical Director on complex cases.
- Demonstrate expertise in the application of InterQual and MCG guidelines.
RN Case Manager
Medical City Denton
Denton, TX
05.2009 - 05.2012
- Worked as a nurse specializing in utilization review and discharge planning.
- Communicated regularly with family members regarding patient care needs and progress toward goals.
RN Case Manager
United Healthcare
Richardson, TX
11.2007 - 01.2009
- Assisted in setting up in-home services for patients to prevent hospitalization and maintain the highest level of independence in their environment.
Registered Nurse
Medical City Denton
Denton, TX
01.2006 - 10.2007
- Delivered patient care in a telemetry unit.
- Administered medications as prescribed by physicians, following established protocols and guidelines.
- Maintained current knowledge of healthcare trends, standards of care, treatments, drugs, and therapies used in Telemetry nursing.
Travel Registered Nurse
American Mobile Healthcare
San Diego, CA
06.2002 - 09.2005
- Provided direct and indirect patient care according to established standards and protocols.
- Administered medications as prescribed by physicians and monitored the effect on patients' conditions.
- Responded quickly and effectively to emergency situations or changes in patient's condition.
Education
Master of Science - Nursing
Capella University
Minneapolis, MN09-2024
Associate of Science - Nursing
Bluegrass Community And Technical College
Lexington, KY05-1993
Skills
- Self-Directed
- InterQual application
- Case presentation
- Medical guidelines application
- Quality assurance
- Discharge planning
- Complex case collaboration
- Effective communication
- Problem solving
- Inpatient care management
- Utilization review
Education and Training
other,other
Certification
Registered Nurse
Timeline
Senior Clinical Quality RN
United Healthcare
01.2025 - Current
INPATIENT CARE MANAGER
Optum, UnitedHealth Group
06.2012 - Current
RN Case Manager
Medical City Denton
05.2009 - 05.2012
RN Case Manager
United Healthcare
11.2007 - 01.2009
Registered Nurse
Medical City Denton
01.2006 - 10.2007
Travel Registered Nurse
American Mobile Healthcare
06.2002 - 09.2005
Master of Science - Nursing
Capella University
Associate of Science - Nursing
Bluegrass Community And Technical College