Edie Wood

• Responsible for conducting utilization review of patient records to ensure that the level of care rendered is medically necessary and appropriate.
• Collaborates with the attending physician, consultants, secon level physician reviewers and the Care Management staff utilizing evidence-based guidelines and critical thinking.
• Review denials with other UR RNs and physician advisors to determine root case of denials and implement denial prevention strategies.

Responsible for the review of medical records for appropriate admission status and continued hospitalization.

Work in collaboration with the attending physician, consultants, second level physician reviewer and the Care Management staff utilizing evidence-based guidelines and critical thinking.

Collaborates with physician advisors & other UR RN regarding Concurrent Denials to determine root cause of denials and implement denial prevention strategies.

Conducts admission and continued stay reviews per the Utilization Management Review guidelines to ensure that the hospitalization is warranted based o established criteria and critical thinking.

• Oversee the daily operation of the System Case Management and Social Services programs, ensuring accountability, effectiveness, efficiency, and compliance with regulatory and accreditation agencies
• Responsible for the administration and implementation of technical and Health System standardized processes as well as ensuring the implementation and governance of all Case Management Health System policies and procedures
• Primarily responsible for ensuring hospital has effective processes, policies, and procedures for ensuring patient care is integrated between payors and providers, thus resulting in cost-effective, quality care with a focus on utilization management
• This position standardizes processes where possible; ensures hospital level accountability, efficiency, and productivity; and institutes and maintains Case Management best practices
• Ensures up-to-date knowledge permeates Facility Case Management departments
• Also responsible for providing strategic direction and leadership for the clinical documentation and quality improvement function within each local care delivery market and throughout the System
• Accountable for leading the development and implementation of national standards for Clinical Documentation and Improvement Plan
• Provide direct support to Case Management Director.

• Provide patient care for the Pulse Heart Institute
• Manage and provide direct patient care of patients with cardiac and stroke-neuro diagnoses as directed by physicians and unit driven protocols.

• Support the growth and development of DH as a new start up in the Tacoma market through channel partner relationships, community relationships, and marketing tactics through business development, account management, marketing strategy, analytics, events and event planning, and product development.

• Clinical RN and Patient Educator
• Responsible for completing initial clinical assessment of patients and their families, admission and teaching for patient in the hospital in need of IV home infusion, ie Inotropes, Antibiotics, TPN
• Also responsible for building relationships with Acute Care facilities and community referral sources to assist with expanding PIPS services.

• Fulfill care management role in the inpatient setting, including but not limited to the following: Complete early assessment of patients admitted to the inpatient units to ensure proper and timely dc planning; Care management of trauma patients including providing resources for post dc follow-up care, discharge planning and assisting patient and their family with patient transition back to their community; Assist patients and the health care system with obtaining appropriate authorization for procedures, post discharge placement, Durable Medical Equipment, post discharge procedures as needed for the continuum of care
• Coordinate care with the Outpatient Care Managers for specific patient populations as patient needs are identified.

• Assist the injured employee and facilitate the employee's return to work through the identification of the medical services needed, the arrangement for those services to be provided, to advocate for the employee's medical needs through communication with all medical providers, and to educate the employee on the employee's role in the recovery process.

• Provide ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs
• Manage the overall goal of enhancing the quality of patient outcomes and satisfaction and promoting continuity of care while integrating and coordinating utilization management and review with appropriate discharge planning.

• Provide ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs
• Manage the overall goal of enhancing the quality of patient outcomes and satisfaction and promoting continuity of care while integrating and coordinating utilization management and review with appropriate discharge planning.

• Responsible for providing overall and direct care to patients in the Intensive Care Unit
• Experienced with management of critical care patient needs including, but not limited to: cardiac (pre and post surgical), respiratory distress/arrest, cardiogenic shock, multi-systems organ failure, trauma/neuro and CVA, on the ventilator, multiple IV medications, CRRT and ICP monitoring.

• Responsible for providing overall and direct care to patients in the Intensive Care Unit
• Experienced with management of critical care patient needs including, but not limited to: cardiac (pre and post- surgical), respiratory distress/arrest, cardiogenic shock, multi-systems organ failure, trauma/neuro and CVA, on the ventilator, multiple IV medications, CRRT and ICP monitoring.

• Travel Nurse, took multiple contract assignments as a critical care RN, worked in various settings such as: CVICU, CCU, MICU, SICU, & Burn Unit
• Floated to other similar units such as Telemetry or PCU as directed by each hospital
• Example of a few hospital systems that I worked in were University of North Carolina, Ohio State University, and University of Wisconsin.

• Provide critical nursing care to patients in the ICU, including but not limited patients on mechanical ventilation, on pressor support for the following diagnoses: MI, CVA, Respiratory Failure, & Multi-organ failure, Cardiogenic Shock
• Also was a SWAT & Resource RN for the hospital as needed.

• Worked as a Graduate RN in the Critical Care Unit
• Finished a 3-month preceptorship then because of family emergency moved to Washington State.

• Assisted Good Samaritan Hospital in a Care Manager role as the Case Management team transitioned to a new model of Personal Health Partner-Health Navigation
• Provide ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs in the ED and Inpatient units
• Manage the overall goal of enhancing the quality of patient outcomes and satisfaction and promoting continuity of care while integrating and coordinating utilization management and review with appropriate discharge planning.

• Clinical support for HCM and HF patients in clinic and via phone calls, including but not limited to assisting with symptom assessment & management, prescription requests, and procedure/visit scheduling
• Enter orders for patients in need of genetic testing
• Assist with appropriate interdisciplinary team needs, patient education, provider referrals for longitudinal care
• Pre-service assessment for potential HCM patients
• Other duties as requested by leadership team.