HEATHER SCULLY
Erie,PA
Summary
Experienced Utilization Management RN specializing in medical necessity reviews and multidisciplinary collaboration. Managed high-volume caseloads, ensuring compliance with regulatory standards. Skilled in clinical documentation and discharge planning, enhancing patient care and optimizing resource utilization.
Overview
27
27
years of professional experience
1
1
Certification
Work History
Professional Development & Family Commitments
Career Break
11.2023 - Current
- Maintained active RN licensure and pursued professional development through targeted training in utilization review, InterQual/MCG criteria, and payer policy updates to enhance clinical practice.
- Completed AI Certificate Program to develop analytical, documentation, and technology-driven workflow skills applicable to nursing.
- Balanced family responsibilities while pursuing ongoing education and preparing for reentry into RN workforce, demonstrating commitment to professional growth.
Utilization Management RN
Lucent Health Solutions
09.2009 - 11.2023
- Applied InterQual/MCG criteria and collaborated with providers to obtain supporting documentation for inpatient acute, inpatient surgery, outpatient surgery, IV infusion, chemotherapy, LTAC, SNF, PT/OT/ST.
- Reviewed medical records to determine medical necessity and appropriate level of care for inpatient acute, inpatient surgery, post-acute, LTAC, SNF, IV infusion, chemotherapy, and PT/OT/ST, ensuring compliance with standards.
- Managed high-volume caseloads with accuracy and timeliness, ensuring adherence to payer, regulatory, and hospice-specific requirements to maintain compliance and quality standards.
- Prepared cases for Physician Reviewers and coordinated secondary review processes, including hospice eligibility and recertification, to support quality patient care and documentation accuracy.
- Collaborated with providers, case managers, and hospice teams to enhance care quality and manage costs.
RN, Oncology Outpatient
Regional Cancer Center
09.2007 - 09.2009
- Delivered outpatient oncology care, administering IV chemotherapy and monitoring symptoms to ensure effective treatment.
- Monitored vitals and adjusted medications during treatment to ensure patient safety and effective symptom management.
- Educated patients on diagnoses, chemotherapy regimens, palliative care, and treatment expectations to enhance understanding and compliance.
- Supported healthcare team during bone marrow biopsies and intrathecal chemotherapy procedures in clinical settings.
RN, PACU / Inpatient Acute/ Medical Surgical
Cleveland Clinic
03.2005 - 09.2007
- Assessed post-operative patients and monitored recovery progress, facilitating safe transitions from surgery.
- Educated patients and families on post-surgical care, mobility, wound care, and pain management to enhance recovery outcomes.
- Managed IV infusion pumps and ensured accurate medication delivery for patient safety.
RN, Inpatient Acute/Medical Surgical / PACU / Scoliosis Care Coordinator
Shriners Hospital for Children
01.1999 - 01.2005
- Provided post-operative care in the PACU, monitoring patient status, managing pain, and responding promptly to changes in condition.
- Coordinated care for scoliosis patients requiring spine surgery, facilitating communication between surgeons, providers, and families to improve patient experience.
- Provided direct inpatient nursing care to pediatric patients with complex medical and orthopedic conditions, enhancing patient comfort and recovery.
- Collaborated with multidisciplinary teams to enhance surgical readiness and recovery, supporting better long-term outcomes for pediatric orthopedic patients.
Education
AI Certificate Program -
04-2026
Bachelor of Science - Nursing
Edinboro University of Pennsylvania
Skills
- Family advocacy
- Family support coordination
- Caseload management
- Clinical documentation review
- Multidisciplinary collaboration
- Remote workflow management
- Microsoft Office suite proficiency
- Client support
Certification
- Registered Nurse Active Multistate
Timeline
Professional Development & Family Commitments
Career Break
11.2023 - Current
Utilization Management RN
Lucent Health Solutions
09.2009 - 11.2023
RN, Oncology Outpatient
Regional Cancer Center
09.2007 - 09.2009
RN, PACU / Inpatient Acute/ Medical Surgical
Cleveland Clinic
03.2005 - 09.2007
RN, Inpatient Acute/Medical Surgical / PACU / Scoliosis Care Coordinator
Shriners Hospital for Children
01.1999 - 01.2005
AI Certificate Program -
Bachelor of Science - Nursing
Edinboro University of Pennsylvania