JANET BOWEN
Brooklet ,GA
Summary
RN Case Manager with extensive experience at East Georgia Regional Medical Center, specializing in utilization review and patient assessment. Demonstrated success in improving care coordination and compliance standards while leading staff training initiatives. Skilled in interdisciplinary collaboration and driving operational efficiency through effective discharge planning strategies.
Overview
12
12
years of professional experience
1
1
Certification
Work History
RN Case Manager/UR Specialist
East Georgia Regional Medical Center
Statesboro, Georgia
07.2023 - Current
- Reviewed patient records to ensure compliance with medical necessity criteria.
- Assessed treatment plans for appropriateness and adherence to clinical guidelines.
- Educated healthcare staff on best practices for documentation and approval processes.
- Maintained knowledge of current healthcare policies and regulatory requirements related to utilization review.
- Participated in interdisciplinary team meetings to discuss complex cases and care coordination.
- Assessed patient medical records to determine the appropriateness of requested services and procedures.
RN UR NURSE
CHS Health Systems
Nashville, TN
04.2021 - 07.2023
- Reviewed patient records to ensure compliance with medical necessity criteria.
- Documented utilization review findings in the electronic health record system.
- Maintained knowledge of current healthcare policies and regulatory requirements related to utilization review.
- Assessed patient medical records to determine the appropriateness of requested services and procedures.
- Served as a resource for staff members seeking guidance on utilization review matters.
- Conducted reviews of inpatient utilization for compliance with admission criteria and concurrent review requirements.
RN Utilization Nurse
St Joseph Hospital
Savannah, GA
02.2018 - 03.2021
- Reviewed patient records to ensure compliance with medical necessity criteria.
- Assessed treatment plans for appropriateness and adherence to clinical guidelines.
- Documented utilization review findings in the electronic health record system.
- Maintained knowledge of current healthcare policies and regulatory requirements related to utilization review.
- Participated in interdisciplinary team meetings to discuss complex cases and care coordination.
- Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
Case Managment Director
East Georgia Regional Medical Center
Statesboro, GA
05.2013 - 02.2018
- Oversaw strategic planning initiatives to align corporate goals with operational activities.
- Developed training programs for staff to improve skills and operational efficiency.
- Led cross-functional teams to enhance communication and collaboration across departments.
- Recruited, trained, supervised, evaluated and mentored staff members.
- Directed the organization's daily operations, ensuring compliance with applicable laws and regulations.
- Facilitated collaboration between teams by encouraging open communication channels.
- Established relationships with vendors and suppliers to secure favorable terms for materials or services.
- Collaborated with senior leadership to set long-term objectives for the company.
- Coordinated activities with other departments to expedite work and improve collaboration.
Education
Associate Degree in Nursing - Nursing Practice
Armstong University College
Savannah, GA01-1996
Skills
- Utilization review
- Patient assessment
- Care coordination
- Electronic health records
- Compliance standards
- Interdisciplinary collaboration
- Staff training
- Leadership techniques
- Discharge planning
- Problem solving
Certification
- ASSOCIATE DEGREE NURSING* 127451* 1/1996
Timeline
RN Case Manager/UR Specialist
East Georgia Regional Medical Center
07.2023 - Current
RN UR NURSE
CHS Health Systems
04.2021 - 07.2023
RN Utilization Nurse
St Joseph Hospital
02.2018 - 03.2021
Case Managment Director
East Georgia Regional Medical Center
05.2013 - 02.2018
Associate Degree in Nursing - Nursing Practice
Armstong University College
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