HEATHER SKADAHL
Milwaukee,WI
Summary
Registered Nurse specializing in Utilization Review and Case management. Expertise in Medical Necessity reviews, level of care determination, concurrent reviews, as well as Prior Authorizations and Denials. A proven ability to collaborate effectively in fully remote environments.
Overview
27
27
years of professional experience
Work History
Clinical Consultation
UMR
09.2025 - Current
- Served as primary liaison between TPA, Client, providers, members, and internal clinical teams to coordinate high-touch healthcare navigation and resolution services.
- Manage complex member cases involving care coordination, benefit interpretation, prior authorizations, claims escalation, and continuity of care planning.
- Performed claims analysis and utilization review for high-risk/high-cost member populations, identifying trends in medical utilization, chronic disease burden, risk exposure, care gaps, and opportunities for cost containment and improved member outcomes.
- Identified and resolved operational workflow discrepancy affecting approximately 10,000 members through trend analysis, SOP review, and cross-functional process improvement initiatives.
- Received Diamond award for increasing my Clients Net Promoter Score of UMR from the Detractor score of 1-2 range, to Promoter score of 9-10.
Charge Nurse – Cardiac/Neuro Telemetry
Aurora St. Luke’s South Shore
10.2021 - 08.2025
- Fast-paced 28-bed Cardiac/Neuro unit. Administered IV drips such as: Insulin, Nitro, Cardizem, Amiodarone and Heparin.
- Organized and delegated tasks during rapid response and high-pressure code situations.
- Managed staffing levels within the unit while ensuring optimal levels of patient care.
- Coordinated patient admissions, discharges, and transfers efficiently.
- Served as a preceptor for new nurses by providing orientation to unit policies and procedures, coaching on clinical skills, and mentoring on professional development issues.
- Co-Chaired Practice Council responsible for development and implementation of an Intentional Rounding Initiative, contributing to a 62% reduction in six-month patient fall rates.
Health Services Manager
Woodlands School
Milwaukee, WI
08.2019 - 08.2021
- Collaborated with medical director to create comprehensive medical policies, enhancing health service delivery.
- Developed and delivered hands-on training for school personnel in AED operation, CPR certification readiness, seizure emergency medication administration, and anaphylaxis response. Running mock emergency drills and strengthening overall campus emergency preparedness.
- Oversaw immunization compliance for students by utilizing the Wisconsin Immunization Registry and ensuring adherence to Wisconsin Department of Health and Services regulations through systemic record audits, parent notification workflows, and enforcement of state-mandated compliance timelines.
- Managed full scope of school health office operations, including acute clinical assessment and triage, medication administration and compliance, and chronic disease management. Developed and implemented IEP's and emergency care plans while coordinating care with parents, providers and multidisciplinary teams; ensured regulatory compliance, infection control oversight and tracking, and accurate clinical documentation for pediatric population.
RN Hospice Case Manager
Hometown Hospice & Homecare
01.2015 - 08.2019
- Provided emotional support to patients and families during end-of-life transitions, fostering compassionate care.
- Provided guidance on managing symptoms related to terminal illnesses such as pain control techniques or nutrition counseling.
- Facilitated referrals for social work counseling and spiritual care, enhancing patient support services.
- Attended weekly case conferences to review current cases and develop treatment plans for new admissions.
- Collaborated closely with physicians and other healthcare providers to coordinate comprehensive patient care.
Telehealth Case Manager
Quad Graphics
01.2010 - 01.2015
- Managed 60–75 complex disease cases monthly in fully remote insurance-based model, ensuring efficient case resolution.
- Conducted prior authorizations and medical necessity reviews using evidence-based guidelines.
- Facilitated communication between clients and service providers to enhance support.
- Educated clients on available services and community resources for better outcomes.
- Provided case management services including intake, assessment, crisis intervention, advocacy, referral, and monitoring for families, facilitating access to necessary resources.
Quality Analyst & Clinical Documentation Specialist
Heartland Homecare & Hospice
01.2008 - 01.2010
- Supported facility readiness for CMS/Medicare regulatory survey, ensuring compliance with documentation, clinical standards, and quality reporting requirements. Identified and corrected documentation gaps to ensure alignment with federal regulatory and quality of care standards.
- Collaborated with teams to develop and implement quality improvement initiatives.
- Performed analysis of ICD-9 coding accuracy and clinical documentation alignment to support appropriate reimbursement and reduce coding-related compliance and audit risk.
RN Case Manager & Supervisor
Visiting Nurse Association
01.1999 - 01.2008
- Functioned as PM Supervisor for a home care agency, directly managing a team of 6 staff and overseeing scheduling, care coordination, and operational workflows to ensure timely delivery of services and continuity of care.
- Oversaw weekend scheduling operations for 80-100+ home care patients across three counties, coordinating complex staffing logistics by prioritizing time-sensitive services, patient preferences, and geographical efficiency to ensure continuity and timely delivery of cares.
- Coordinated skilled nursing services and interdisciplinary care planning, enhancing quality of care for complex patient populations.
- Provided telephonic clinical triage for home care patients, assessing acuity and determining appropriate level of care; coordinating urgent in-home nursing interventions or escalated to emergency department or 911 services when appropriate.
- Was also a Case Manager in the field, on high volume days.
Education
Associate of Science - Nursing
Suomi College
Hancock05-1992
Skills
- Utilization Review
- Medical Necessity Review
- Telephonic Case Management
- Prior Authorizations
- Appeals and Denials
- Working knowledge of Interqual guidelines
- Clinical Documentation Review
- Chronic Condition Management
- Telephonic Case Management
- Electronic Documentation Systems including EPIC, HCHB, Cerner, and Roadnotes,Aerial, Jacada, Plan Advisor
- Excell, Powerpoint, Word, Teams
- CCM certification in progress
Personal Information
License: Compact State RN License
Timeline
Clinical Consultation
UMR
09.2025 - Current
Charge Nurse – Cardiac/Neuro Telemetry
Aurora St. Luke’s South Shore
10.2021 - 08.2025
Health Services Manager
Woodlands School
08.2019 - 08.2021
RN Hospice Case Manager
Hometown Hospice & Homecare
01.2015 - 08.2019
Telehealth Case Manager
Quad Graphics
01.2010 - 01.2015
Quality Analyst & Clinical Documentation Specialist
Heartland Homecare & Hospice
01.2008 - 01.2010
RN Case Manager & Supervisor
Visiting Nurse Association
01.1999 - 01.2008
Associate of Science - Nursing
Suomi College