Haleigh Santapa
Plainfield,IL
Summary
Dedicated and detail-oriented nursing professional with a strong background in information technology and healthcare systems. Proven expertise in leveraging technology to enhance client satisfaction, streamline operations amongst a number of different integrated teams, and improving workflows. Committed to bridging the gap between clinical operations and technology.
Overview
3
3
years of professional experience
Work History
Clinical Policy Specialist
Cohere Health
01.2023 - Current
- Responsible for maintaining a database of over a thousand medical policies across 14 different clients.
- Conducted ongoing reviews of existing policies, identifying areas for improvement or revision based on changing regulatory environments or organizational needs.
- Managed relationships with external partners, fostering collaboration and information sharing among stakeholders.
- Collaborated with cross-functional teams to address complex policy issues, ensuring efficient resolution and stakeholder satisfaction.
- Develop and create comprehensive demos for potential clients to tailored to their specific needs.
Utilization Review Nurse
Cedar Cares
06.2022 - 01.2023
- Worked independently and autonomously under general instructions while collaborating with other team members as needed.
- Efficiently used multiple systems on multiple screens simultaneously.
- Successful team leadership, relationship building, critical analysis, and written and verbal communication skills.
- Knowledge of payers, payer systems, cost effective utilization management and InterQual and MCG
- Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
- Collaborated with IT department to develop and modify prior authorization app that streamlines the prior authorization experience.
- Working knowledge of over 180 CAM policies and 3,500 CPT codes.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
Education
Vocational Degree - Nursing
Ivy Tech Community College of Indiana
Indianapolis, IN05-2013
Skills
- Policy analysis
- Production support
- JIRA
- Figma
- Problem-solving
- Teamwork and collaboration
- Time management
- Attention to detail
- Multitasking
- Reliability
- Excellent communication
Timeline
Clinical Policy Specialist
Cohere Health
01.2023 - Current
Utilization Review Nurse
Cedar Cares
06.2022 - 01.2023
Vocational Degree - Nursing
Ivy Tech Community College of Indiana
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