Overview
Summary
Work History
Education
Skills
Timeline

Jamie Tesch

Registered Nurse
Clinton Twp,MI

Overview

12
12
years of professional experience
2
2
years of post-secondary education

Summary

Seasoned nursing professional with extensive experience in utilization review. Skilled in analyzing patient care and ensuring compliance with healthcare regulations. Offering proven clinical knowledge, natural interpersonal strengths and technical abilities. Diverse clinical background consisting of managed care, critical care, intermediate care, NICU, hospice/palliative. Strong focus on team collaboration and achieving optimal patient outcomes. Quality-focused and efficiency-driven leader, adaptable and reliable, excelling in dynamic changing healthcare environments that require strong clinical skill in, critical thinking, quick decision-making ad effective communication.

Work History

Utilization Review Supervisor

Molina Healthcare
02.2019 - Current
  • Facilitated productive relationships with stakeholders including physicians, nursing staff, case managers, social workers, payers, patients, families to promote a collaborative approach towards care coordination.
  • Developed comprehensive staff training programs to enhance employees' understanding of utilization review principles and practices.
  • Improved patient care quality by implementing utilization review processes and ensuring adherence to industry standards.
  • Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
  • Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
  • Supported data-driven decision-making by regularly analyzing trends in resource utilization, identifying opportunities for improvement, and implementing best practices.
  • Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
  • Increased staff efficiency by providing ongoing education on proper documentation techniques necessary for accurate claims processing.
  • Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
  • Established team priorities, maintained schedules and monitored performance.
  • Evaluated employee performance and conveyed constructive feedback to improve skills.
  • Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement.
  • Spearheaded implementation of new software systems that streamlined workflow processes within the department leading to increased efficiencies in daily operations.

Utilization Review Nurse

Molina Healthcare
Troy, MI
02.2019 - Current
  • Perform utilization review for inpatient services by analyzing patient records to ensure medical necessity, appropriateness of care and level of service according to state and federal regulations using InterQual criteria and Milliman Care Guidelines (MCG)
  • Utilize critical thinking to apply review criteria to compile an accurate account of the patient’s clinical circumstances and evaluate the need for continued treatment or alternative levels of care based on the patient's condition and insurance guideline
  • Ensure optimum patient outcomes, reduce the misuse of inpatient services and ensure cost effectiveness while providing effective healthcare
  • Demonstrated strong organizational skills by efficiently managing daily workload, prioritizing tasks based on urgency and importance while maintaining compliance with all state and federal regulations and guidelines
  • Maintained confidentiality when handling sensitive information in accordance with HIPAA regulations
  • Identified opportunities for improvement and assisted with development in processes related to utilization management functions by communicating regularly with internal departments regarding changes in policies or procedures that affect utilization review activities
  • Collaborated with the multidisciplinary team to facilitate quality outcomes while optimizing cost containment strategies and appropriate referrals to other clinical programs.

Staff Nurse

NICU - Ascension St. John Hospital, American Heart Association
Detroit, MI
08.2017 - 02.2019
  • Responsible for the direct care of preterm/term critically ill infants in the Special Care Nursery (SCN) and NICU
  • Participated in continuous professional development to stay current with best practices in neonatal nursing.
  • Cultivated strong relationships with parents and caregivers, providing emotional support throughout their infant''s NICU stay.
  • Performed comprehensive assessments of neonatal patients, identifying subtle changes in condition that required medical intervention or modification of treatment plans.
  • Assisted with complex procedures such as intubation, umbilical line placement, and lumbar punctures to ensure optimal patient outcomes.
  • NRP certified

Case Manager/Admissions Nurse

Seasons Hospice & Palliative Care
Madison Heights, MI
04.2016 - 08.2017
  • Provided care management to critically ill patients during the final stages of life
  • Thorough understanding of terminal diseases, appropriate comfort care measures, signs of imminent death
  • Ensure death with dignity
  • Strict compliance with Medicare/private insurance guidelines related to hospice care admission and recertification qualifications.

Staff Nurse

CVICU – DMC Harper Hospital
Detroit, MI
11.2013 - 06.2016
  • ICU (cross trained) Nurse specializing in cardiopulmonary care
  • Experienced Charge Nurse/Clinical Preceptor with excellent leadership skills; serving as a role model and mentor to precept new staff regarding policies, procedures & expectations in the management and care of critically ill patients & high-tech devices/life sustaining equipment
  • Assisted in Interim Clinical Coordinator position
  • Competent in the care of critically ill patients with numerous mechanical life sustaining devices.

Education

Associate - Science, Nursing

Schoolcraft College, Livonia
08.2011 - 05.2013

Skills

  • Utilization Review - PA, inpatient review, post acute (SNF, SAR, IPR)
  • Managed Care - Medicaid population
  • Experienced Charge Nurse/Clinical Coordinator
  • Orientation & mentoring of new staff
  • Detail oriented & organized
  • Time management & Prioritization - effectively managing competing priorities and multiple deadlines
  • Critical thinking & Problem solving - ability to anticipate/solve problems
  • Interpersonal and Written Communication
  • Proficient with InterQual, MCG, QNXT, Avality applications
  • Healthcare regulations (state, federal, accrediting bodies)
  • Critical care (ICU, IMCU, NICU)
  • Discharge planning/coordination
  • Hospice/Palliative care experience
  • BLS, ACLS, NRP

Timeline

Utilization Review Supervisor - Molina Healthcare
02.2019 - Current
Utilization Review Nurse - Molina Healthcare
02.2019 - Current
Staff Nurse - NICU - Ascension St. John Hospital, American Heart Association
08.2017 - 02.2019
Case Manager/Admissions Nurse - Seasons Hospice & Palliative Care
04.2016 - 08.2017
Staff Nurse - CVICU – DMC Harper Hospital
11.2013 - 06.2016
Schoolcraft College - Associate, Science, Nursing
08.2011 - 05.2013

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Jamie TeschRegistered Nurse