Outlook
Heather Yount RN BSN CCM
Salemburg,North Carolina
Summary
Seasoned nursing professional offering proven clinical knowledge, natural interpersonal strengths and technical abilities. Knowledgeable about EMR charting, disease monitoring and interdisciplinary collaboration focused on optimizing patient care and support. Quality-focused and efficiency-driven leader.
Overview
29
29
years of professional experience
1
1
Certified Case Manager
1
1
Language
Work History
Care Manager
Wellvana
10.2022 - Current
- Facilitated the multidisciplinary care management process by coordinating the development and implementation of tools and systems for effective, efficient care management
- Remotely monitored complex medical needs such as CHF, diabetes and mental health for over 140 patients. Conducted comprehensive assessment of patient's needs.
- Developed, monitored and evaluated personalized care plans.
- Developed strong rapport with patients and families through empathetic listening and compassionate communication techniques.
- Maintained accurate documentation of patient interactions and progress notes in electronic medical records systems.
- Coordinated referrals to specialists, hospitalizations, ER visits, ancillary testing, and other enabling services for patients.
- Promoted quality patient care outcomes while supporting appropriate utilization/resource management along the continuum of care..
- Reduced readmission rates through diligent discharge planning and thorough patient education on self-care practices.
Utilization Management/Prior Authorization RN
United Health Group
01.2021 - 01.2022
- Performed prior authorization reviews using applicable benefit plan documents, evidence-based medical policy and state specific guidelines, while remaining compliant with benefit standards
- Perform initial and concurrent review of cases applying evidenced-based criteria (i.e
- MCG/Interqual criteria)
- Applied clinical expertise when discussing case with internal and external Case Managers and Physicians
- Functioned as a member of a self-directed team to meet specific individual and team performance metrics
- Adapted to a highly changing environment and a heavy case load.
- Coordinated seamless transitions of care across multiple settings including acute care hospitals, rehabilitation facilities, and home care services.
- Increased efficiency in case management documentation by maintaining organized records and utilizing electronic medical record systems.
Prior Authorization Nurse Medical
Anthem (contract)
01.2020 - 01.2021
- Conducted pre-certification, continued stay reviews, care coordination, appeals and discharge planning for appropriateness of treatment to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts
- Simultaneously navigated software systems such as ACMP, Milliman, OMPTA, WellPoint, Knowledge Library, Skype and Microsoft Office.
- Enhanced patient care by assessing insurance coverage and obtaining prior authorization for medical procedures.
- Collaborated with healthcare providers to ensure accurate submission of required documentation for timely authorizations.
- Worked closely with case managers to facilitate appropriate utilization of healthcare resources through prior authorization process.
- Expedited urgent requests for prior authorization, ensuring timely access to critical medical treatments.
- Conducted thorough reviews of medical records, identifying necessary documentation to support prior authorization requests.
Utilization Management/Prior Authorization RN
United Health Group
01.2017 - 01.2020
- Reviewed over 125 485’s and supportive clinical documentation on weekly basis for medical necessity and accuracy
- Performed prior authorization reviews using applicable benefit plan documents, evidence-based medical policy and state specific guidelines, while remaining compliant with benefit standards.
- Coordinated seamless transitions of care across multiple settings including acute care hospitals, rehabilitation facilities, and home care services.
- Increased efficiency in case management documentation by maintaining organized records and utilizing electronic medical record systems.
RN Case Manager/Clinical Education
Harriott Home Health
01.2016 - 12.2016
- Performed physical assessments, delivered medication, and provided chronic disease management for low income patients
- Identified methods to reduce care costs while maintaining high level of quality
- Undertook quality control operations and collaborated with other medical professionals to ensure effective service delivery
- Verified accuracy of all clinical documentation and ensured completeness, and goal accomplishment related to patient education.
RN Case Manager
Baystate Medical Center VNA
01.2014 - 01.2016
- Delivered case management services for large case load that covered wide variety of co-morbidities
- Collaborated with senior medical staff to develop assessments and treatment plans, and to facilitate and advocate for patient recovery needs
- Provided treatment efforts to patients dealing with chronic diagnosis include COPD, asthma, CHF, diabetes, and cardiac conditions.
- Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
- Provided emotional support to patients coping with chronic illness or end-of-life decisions, fostering resilience during difficult times.
- Collaborated closely with physicians to develop individualized treatment plans, supporting optimal patient outcomes.
- Reduced hospital readmission rates through effective case management and patient education on self-care techniques.
Intensive Case Manager
McKesson
01.2013 - 01.2014
- Assisted defined populations with clinical care needs in accordance with computer-based algorithms, proper treatment protocols, and guidelines for remote medical treatment
- Conducted teleconference and in-person visits based on QM guidelines, ensuring compliance with product specific performance metrics.
- Improved community resources access for clients through effective collaboration with local service providers.
- Promoted client self-sufficiency with comprehensive assessments, goal setting, and regular progress monitoring.
- Ensured continuity of care during crisis situations by coordinating emergency services, assessing risk factors, and creating safety plans for vulnerable clients.
- Enhanced client outcomes by developing and implementing personalized case management plans.
Primary Care Nurse/Case Manager/Clinical Nurse Liaison
Home and Community Health Care Service
01.2011 - 01.2013
- Coordinated medical treatment efforts between a variety of key strategic partners including hospitals, SNF’s, MD’s, and agencies
- Administered patient and family education and held meetings with referral and payer representatives
- Designed and led patient reintegration into community through partnerships with wellness clinics and referring agencies
- Conducted evaluations of treatment plans and monitored goal performance.
Education
Bachelor of Science in Nursing - Nursing
Jacksonville University
Jacksonville, FL06.2020
Diploma in Nursing - Nursing
Baystate Medical Center, School of Nursing
Springfield, MA06.1995
Skills
- Chronic Disease Management
- Remote disease monitoring
- CHF, Diabetes monitoring
- Therapeutic listening
- Clinical assessment
- Care Planning
- Clinical Documentation
- Patient Education
- Community Resources
- Quality Improvement
- Case Management
- Critical Thinking
- Microsoft office, ACMP, Milliman, OMPTA, WellPoint, Knowledge Library, EMR, Allscripts, McKesson, Deltek, MYSIS, MALTSS, Jabber, WebEx, LTMS, MMIS and Skype
Certification
- Certified Case Manager 4211052
- Registered Nurse E57518 – State of Connecticut
- Registered Nurse RN2270272 – State of Massachusetts
- Registered Nurse 316991 – State of North Carolina-compact license
- Registered Nurse – State of California 95218320
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Accomplishments
- Documentation - Ensured charting accuracy through precise documentation.
- Quality Assurance - Ensured and enforced medical office compliance with HIPAA, OSHA and CLIA regulations for maximum quality and control.
- Implementation - Assisted in implementation of new tracking system that resulted in improved patient care.
- Patient Care - Delivered compassionate care that exceeded hospital requirements. Successfully provided quality care to over 140 patients in remote environment.
Affiliations
- American Nurse Association
Quote
Your most unhappy customers are your greatest source of learning.
Bill Gates
Work Preference
Work Type
Full TimeWork Location
RemoteImportant To Me
Work-life balanceFlexible work hoursPaid time offWork from home optionCommunity Service
- Boy Scouts of America leader for over 10 years
Software
Excel
Jabber
Teams
Acclivity
Wiseman
Interests
Reading
Sewing
Puzzles
Timeline
Care Manager
Wellvana
10.2022 - Current
Utilization Management/Prior Authorization RN
United Health Group
01.2021 - 01.2022
Prior Authorization Nurse Medical
Anthem (contract)
01.2020 - 01.2021
Utilization Management/Prior Authorization RN
United Health Group
01.2017 - 01.2020
RN Case Manager/Clinical Education
Harriott Home Health
01.2016 - 12.2016
RN Case Manager
Baystate Medical Center VNA
01.2014 - 01.2016
Intensive Case Manager
McKesson
01.2013 - 01.2014
Primary Care Nurse/Case Manager/Clinical Nurse Liaison
Home and Community Health Care Service
01.2011 - 01.2013
Bachelor of Science in Nursing - Nursing
Jacksonville University
Diploma in Nursing - Nursing
Baystate Medical Center, School of Nursing
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