Jamie Dodson
Dothan
Summary
Healthcare professional driven to deliver high-quality patient care and effective case management. Expertise in care coordination and patient advocacy, fostering strong communication and collaboration within multidisciplinary teams. Known for adaptability and results-oriented approach in dynamic healthcare environments.
Overview
13
13
years of professional experience
Work History
RN, Case Manager, Utilization Review Nurse
Flowers Hospital
07.2023 - Current
- Provided emotional support to patients coping with chronic illness or end-of-life decisions, fostering resilience during difficult times.
- Reduced hospital readmission rates through effective case management and patient education on self-care techniques.
- Served as a key liaison between patients, families, and healthcare providers, fostering open communication and trust among all parties involved in the care process.
- Educated patients and families on available community resources, facilitating access to necessary support services.
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Managed a high volume of cases efficiently by prioritizing tasks and maintaining strict deadlines for completion of reviews.
- Demonstrated strong analytical skills by interpreting complex medical records and synthesizing relevant information for utilization review purposes.
- Maintained strict confidentiality of patient information, adhering to HIPAA regulations and organizational policies regarding privacy and data security.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Performed admission reviews based for medical necessity based upon Interqual and Mcg guidelines.
Utilization Review Specialist
Community Health Systems
12.2021 - 06.2023
- Enhanced patient care by conducting thorough utilization reviews and ensuring adherence to treatment plans.
- Proactively addressed potential barriers to care during the review process, connecting patients with appropriate resources such as financial assistance programs or support groups.
- Conducted training sessions for staff members on best practices in utilization review, fostering a culture of continuous learning and improvement.
- Managed a high volume of cases efficiently by prioritizing tasks and maintaining strict deadlines for completion of reviews.
- Demonstrated strong analytical skills by interpreting complex medical records and synthesizing relevant information for utilization review purposes.
- Maintained strict confidentiality of patient information, adhering to HIPAA regulations and organizational policies regarding privacy and data security.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Performed admission reviews based for medical necessity based upon Interqual and Mcg guidelines.
- Evaluated patient histories, complaints, and current symptoms.
Clinical Liaison
Noland Hospital
11.2020 - 11.2021
- Increased patient satisfaction by effectively communicating with interdisciplinary teams and providing appropriate clinical recommendations.
- Collaborated with marketing efforts to showcase facility strengths and attract new referral sources from local hospitals or community-based organizations.
- Developed strong rapport with community partners by attending local health fairs, conferences, or networking events to promote the facility''s programs and services.
- Served as a liaison between patients and their insurance providers, advocating for coverage of necessary treatments and services.
- Streamlined the referral process for smoother patient transitions into post-acute care settings through meticulous documentation and timely communication.
- Conducted thorough assessments of patients'' medical histories, diagnoses, prognoses, medications, and treatment goals to determine eligibility for specific programs or services.
- Verified patient insurance eligibility and entered patient information into system.
RN, Case Manager, Utilization Review Nurse
Flowers Hospital
03.2012 - 10.2020
- Provided emotional support to patients coping with chronic illness or end-of-life decisions, fostering resilience during difficult times.
- Reduced hospital readmission rates through effective case management and patient education on self-care techniques.
- Served as a key liaison between patients, families, and healthcare providers, fostering open communication and trust among all parties involved in the care process.
- Educated patients and families on available community resources, facilitating access to necessary support services.
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Managed a high volume of cases efficiently by prioritizing tasks and maintaining strict deadlines for completion of reviews.
- Demonstrated strong analytical skills by interpreting complex medical records and synthesizing relevant information for utilization review purposes.
- Maintained strict confidentiality of patient information, adhering to HIPAA regulations and organizational policies regarding privacy and data security.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Performed admission reviews based for medical necessity based upon Interqual and Mcg guidelines.
Education
Associate of Science - Nursing
Darton College
Albany, GA12-2010
Skills
- HIPAA compliance
- Multidisciplinary approach
- Utilization review
- Case management
- Critical thinking
- Training staff
- Strong clinical judgment
- Documentation
- Decision-making
- Attention to detail
Timeline
RN, Case Manager, Utilization Review Nurse
Flowers Hospital
07.2023 - Current
Utilization Review Specialist
Community Health Systems
12.2021 - 06.2023
Clinical Liaison
Noland Hospital
11.2020 - 11.2021
RN, Case Manager, Utilization Review Nurse
Flowers Hospital
03.2012 - 10.2020
Associate of Science - Nursing
Darton College
Similar Profiles
Lori FurrLori Furr
Staff Nurse, Emergency Department at Flowers HospitalStaff Nurse, Emergency Department at Flowers Hospital
Michelle HomanMichelle Homan
Patient Care Technician at FLOWERS HOSPITALPatient Care Technician at FLOWERS HOSPITAL
Cole OdomCole Odom
Telemetry Monitor Technician at Flowers HospitalTelemetry Monitor Technician at Flowers Hospital