Douglas Shoop
Federal Way,Washington
Summary
Conscientious Utilization Review Registered Nurse known for high productivity and efficiency in task completion. Possess specialized skills in patient case review, healthcare policy compliance, and interdisciplinary communication. Excel in critical thinking, decision-making, and time management to ensure optimal outcomes in fast-paced environments. Seasoned Clinical Nurse Reviewer with relevant experience in healthcare settings. Skilled in patient care review, medical record analysis, and healthcare auditing. Strengths include strong analytical skills, ability to maintain excellent communication with multidisciplinary teams, and commitment to improving patient care quality. Significant impact made by identifying gaps in patient care and recommending changes to improve health outcomes.
Overview
20
20
years of professional experience
Work History
Lead Utilization Review Nurse
Physicians of Southwest Washington
Olympia, WA
02.2023 - Current
- Conducted thorough review of patient medical records to assess the suitability of requested services and procedures.
- Assessed inpatient utilization through compliance reviews to verify adherence to admission criteria and concurrent review requirements.
- Maintained up-to-date knowledge of health plan benefits, policies, procedures, regulations, coding guidelines.
- Collaborated with multidisciplinary teams on developing strategies for improving care quality and controlling costs.
- Identified opportunities for improvement within the utilization review process through data analysis.
- Provided education to providers regarding utilization management processes and protocols.
Director of Quality Control Management
Valenz
Phoenix, AZ
06.2023 - 02.2024
- Developed strategies for continuous improvement within the organization's processes, products, services, or customer satisfaction levels.
- Provided guidance and support to team members regarding regulatory requirements and best practices in quality management systems.
- Created comprehensive reports on quality assurance activities for senior management review.
- Coordinated the development of corrective action plans based on audit findings.
- Discovered opportunities for performance improvement through data analysis and report assessment.
UM Nurse & Quality Mgmt. Coordinator
Trustmark
Lancaster, PA
02.2019 - 06.2023
- Assisted in the review of medical records for utilization management purposes.
- Maintained current knowledge of health care regulations, policies, and procedures related to utilization management.
- Analyzed trends in denials or appeals received from providers and made recommendations accordingly.
- Compiled and organized data from various sources to facilitate case reviews.
- Developed education materials for providers regarding utilization review processes.
Registered Nurse, Trauma ICU & Operating Room
Grand Strand Medical Center HCA
Myrtle Beach, SC
03.2017 - 02.2019
- Responded quickly to life-threatening situations by providing appropriate interventions.
- Maintained accurate documentation of patient records in accordance with HIPAA regulations.
- Performed physical examinations and assessments of patients' medical histories.
- Assisted doctors during medical & surgical procedures.
- Provided preoperative, intra-operative and postoperative care for patients undergoing a variety of surgical procedures.
Registered Nurse
Dr. William Greer's Office
Ocean City , Maryland
09.2014 - 03.2017
- Monitored vital signs, administered injections, and provided assistance with medical procedures in a primary care physician environment.
Director of Wellness
Gull Creek Senior Living Community
Berlin, Maryland
07.2013 - 09.2014
- Provided clinical guidance and direction to nursing staff to proper clinical care and worked with interdisciplinary team in the delivery of care to a population of senior patients.
Nurse Manager
Aurora Senior Living
Princess Anne, Maryland
09.2012 - 07.2013
- Coordinated interdisciplinary team care in the delivery of services to a population of long-term care patients.
Chief Executive Officer/ Chief Nursing Officer
HealthSouth LTACH/LifeCare LTACH
Mechanicsburg , Pennsylvania
10.2006 - 05.2012
- Promoted from Chief Nursing Officer to Chief Executive Officer while hospital was owned by HealthSouth. Subsequently, led transition to LifeCare Hospital System ownership.
Nurse Manager of Critical Care Division
Chambersburg Hospital
Chambersburg, Pennsylvania
06.2004 - 10.2006
- Managed and oversaw all aspects of Critical Care Services in a large community hospital
Education
Bachelor of Science - Psychology
Pennsylvania State University
Harrisburg, PA12-1999
Diploma in Nursing - Nursing - Registered Nurse Program
Lancaster General School of Nursing
Lancaster05-1992
Diploma in Nursing - Nursing - Registered Nurse Program
Millersville University of Pennsylvania
Millersville, PA05-1992
MSN Program - Credits Earned - Nurse Leadership
Seattle Pacific University
Seattle, WASkills
- Utilization Management
- Healthcare regulations
- Quality Improvement
- Records analysis
- Leadership and Decision Making
- Medicare Knowledge
- Commercial insurance
- Quality Management Systems
- Performance Improvement
- Organizational Skills
- Compliance review
- Critical Care
- Licensed RN
- Report Development
References
References available upon request.
Timeline
Director of Quality Control Management
Valenz
06.2023 - 02.2024
Lead Utilization Review Nurse
Physicians of Southwest Washington
02.2023 - Current
UM Nurse & Quality Mgmt. Coordinator
Trustmark
02.2019 - 06.2023
Registered Nurse, Trauma ICU & Operating Room
Grand Strand Medical Center HCA
03.2017 - 02.2019
Registered Nurse
Dr. William Greer's Office
09.2014 - 03.2017
Director of Wellness
Gull Creek Senior Living Community
07.2013 - 09.2014
Nurse Manager
Aurora Senior Living
09.2012 - 07.2013
Chief Executive Officer/ Chief Nursing Officer
HealthSouth LTACH/LifeCare LTACH
10.2006 - 05.2012
Nurse Manager of Critical Care Division
Chambersburg Hospital
06.2004 - 10.2006
Bachelor of Science - Psychology
Pennsylvania State University
Diploma in Nursing - Nursing - Registered Nurse Program
Lancaster General School of Nursing
Diploma in Nursing - Nursing - Registered Nurse Program
Millersville University of Pennsylvania
MSN Program - Credits Earned - Nurse Leadership
Seattle Pacific University
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