Erika West
Springfield,IL
Summary
Accomplished Utilization Management Nurse and Outpatient Care Coordinator with a proven track record at Health Alliance, enhancing patient outcomes through expert utilization management and empathetic patient support. Skilled in reviewing medical records and clinical education, I excel in coordinating care and educating others, significantly improving service delivery efficiency. My approach combines strong nursing judgment with compassionate communication, driving both member satisfaction and cost-effective care.
Overview
24
24
years of professional experience
Work History
Utilization Management Nurse
Health Alliance
06.2021 - Current
- Served as a trusted liaison between members and healthcare providers to facilitate efficient care delivery processes.
- Review medical records in order to determine if members of our managed care company meet criteria for admission to skilled nursing facilities, long term acute care facilities and inpatient rehabilitation facilities.
- Educate case managers and care coordinators on member coverages in relation to post-acute services, information needed for a successful review, time frames to expect, etc.
- Attend and participate in meetings to ensure that member's needs are being met effectively and with cost savings for all involved.
- Communicate approval and denial letters to all parties.
- Answer questions that arise from the results of approvals and denials.
- Coordinate with concurrent review nurse to ensure all documentation is correct for ongoing review.
- Work with my team to ensure all needs are covered in a timely manner.
- Served as a trusted liaison between patients, healthcare providers, and insurance carriers to facilitate efficient care delivery processes.
- Worked closely with medical directors to communicate all necessary information for more complex medical requests.
Outpatient Nurse Care Coordinator
Health Alliance
02.2017 - 06.2021
- Collaborated with multidisciplinary team members to develop individualized care plans for patients.
- Collaborated with interdisciplinary team members to develop and refine care plans for optimal patient outcomes.
- Provided emotional support to patients and their families during difficult health-related situations, fostering trusting relationships between healthcare providers and clients.
- Enhanced patient satisfaction with compassionate and empathetic communication during consultations.
- Educated in hospital discharge instructions, ensured follow-up with primary care physicians and specialists, encouraged health goal setting.
Outpatient UM/Care Coordinator
Health Alliance
05.2014 - 01.2017
- Coordinated member care activities to ensure seamless service delivery across departments.
- Improved member outcomes by assessing care needs and coordinating with healthcare teams.
- Facilitated communication between members and healthcare providers for enhanced understanding and service.
- Reviewed medical records to determine if coverage of various outpatient procedures, home health, and specialty consultations meet criteria for coverage.
- Communicated approval and denial letters and decisions to all parties involved.
- Worked closely with medical directors to communicate all necessary information for more complex medical requests.
Telephone Triage Registered Nurse
Fonemed
11.2009 - 04.2014
- Counseled patients via telephone according to established guidelines and protocols, advising on provider-established plans of care.
- Managed high-stress situations calmly, providing reassurance to distressed callers while gathering necessary information for accurate decisionmaking.
- Obtained case history and gathered triage information to determine appropriate avenue for care.
- Increased efficiency in triage call handling through effective communication and active listening skills.
RN - Specialty Pediatrics
Carle Health
12.2007 - 11.2009
- Collaborated with healthcare team to improve patient care quality and safety.
- Improved patient outcomes by providing comprehensive care and education.
- Documented patient information accurately for seamless transition of care.
- Telephone triage, patient care, advocate for the medically fragile children to obtain services needed. Worked directly with gastrointestinal and neurology pediatricians regularly.
RN - OB/GYN
Multiple
07.2001 - 12.2007
- Provided comprehensive patient care, ensuring adherence to best practices and protocols.
- Conducted thorough assessments of patients to develop tailored care plans.
- Improved patient outcomes by collaborating with multidisciplinary teams.
- Monitored vital signs and administered medications, enhancing patient safety.
- Educated new mothers in care for themselves and their infants.
- Intermittent charge nurse as needed.
- Worked with high risk antepartum to ensure health outcomes of their pregnancies.
- Mother/baby support after delivery.
Education
Bachelor of Science - Nursing
Olivet Nazarene University
Bourbonnais, IL05-2001
Skills
- Patient confidentiality
- Clinical education via telephone
- Telephonic care coordination
- Utilization Management
- Reviewing medical records
- Using nursing judgement
Timeline
Utilization Management Nurse
Health Alliance
06.2021 - Current
Outpatient Nurse Care Coordinator
Health Alliance
02.2017 - 06.2021
Outpatient UM/Care Coordinator
Health Alliance
05.2014 - 01.2017
Telephone Triage Registered Nurse
Fonemed
11.2009 - 04.2014
RN - Specialty Pediatrics
Carle Health
12.2007 - 11.2009
RN - OB/GYN
Multiple
07.2001 - 12.2007
Bachelor of Science - Nursing
Olivet Nazarene University
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