Jennifer L. Lusty
Nashville,Tennessee
Summary
Experienced healthcare leader specializing in nursing clinical practice, utilization management, and regulatory compliance at Vanderbilt University Hospital. Proven success in policy development and performance metrics, enhancing patient outcomes and operational efficiency. Skilled in data analytics and project management, fostering multidisciplinary team collaboration.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Regional Hospitals Utilization Management Manager
Vanderbilt University Hospital
Nashville, TN
01.2023 - Current
- Maintained an up-to-date knowledge base regarding changes in laws and regulations impacting Utilization Management functions.
- Transition of regional hospitals' Utilization Management Departments to the centralized VUH Department of Finance. Assisted with the development of new or revised policies, procedures, protocols, forms, and reports related to utilization management services, in alignment with hospital compliance and federal regulatory bodies.
- Developed standardized nursing workflows based on staffing levels and hospital patient volumes.
- Launched Physician Advisor (PA) program for regional hospitals, incorporating contract recommendations and outlining PA's roles and responsibilities.
- Evaluated denials for compliance with policies, Managed Care contracts, guidelines, and regulations.
- Evaluated performance metrics regarding utilization management outcomes, including length of stay and episode duration, readmission rates.
- Executive report on KPIs and the development of Observation Discharge Goal metrics used to determine the Observation Budget for each regional hospital.
Utilization Management Specialist
Vanderbilt Utilization Medical Center
Nashville , TN
05.2021 - 12.2022
- Emergency Department initial patient chart review, with appropriate status recommendations, by using payer-specific criteria for admission to Vanderbilt University Medical Center.
- Timely and efficient collaboration, and information sharing, with the admitting teams of Utilization Management recommendations for observation or inpatient status.
- PDSA project improvement utilization to improve team collaboration, communication, and education for correct initial admission status, with follow-up recommendations.
- Researched and identified potential cost savings opportunities by analyzing utilization trends.
Nurse Practitioner, Clinic Lead
Vanderbilt Burn Clinic
Nashville, TN
06.2014 - 04.2021
- Management and care for patients presenting to the outpatient VUMC Burn Clinic.
- The role includes the professional development of both clinic and operational protocols, as well as multi-disciplinary team participation.
- Burn care includes initial evaluation, treatment, and management of burn injuries, as well as post-operative care and follow-up for complicated scar management.
- Treatment for infants through geriatric populations, workers' compensation, and any special needs transfers.
- Responsibilities included the development of templates for the workflow and EPIC data system, research, and prehospital collaboration with the Transfer Center.
- Collaboration with multi-disciplinary teams to develop PTSD protocols and standards of care for identified patients.
- Developed protocols for the burn clinic and management.
- Created the Burn Outpatient Clinic training manual, and was a preceptor to two new Burn Nurse Practitioners in the outpatient clinic.
Lung Transplant Coordinator
Vanderbilt Lung Transplant
Nashville, TN
03.2012 - 06.2014
- Management of lung transplant patients pre- and post-operatively in both the outpatient clinic and inpatient settings for acute, chronic lung-related issues, as well as multi-system complications.
- Responsibilities include multi-disciplinary rounds with the transplant team in both the step-down and critical care settings.
- Immunosuppression medication management, management of acute rejection therapies, and antimicrobial therapies for positive bronchoscopy cultures.
- Lung transplant protocol development, review, and research.
RN-II, Team Leader, Preceptor, Staff Nurse
Regional Burn Center
05.2004 - 02.2012
- Company Overview: Vanderbilt University Medical Center
- Responsible for care of up to 2 ICU patients, 3-4 Step down patients, for 12 hour shift.
- Responsibilities include care for 1-2 complex level 1 Burn/ Trauma patients with multiple vasopressor and sedation drips, mechanical ventilation, and daily wound care.
- Preceptor for new nurses, EMTs, and military personnel.
- Team leading includes charge nurse responsibilities for 26 Bed Burn Center.
- Responsibilities include staffing management, audits for quality improvement, bed management communication, and organization and delegation for unit personnel, while promoting efficient quality care.
- Vanderbilt University Medical Center
Education
Doctorate of Nursing Practice - Nursing
Vanderbilt University School of Nursing
Nashville, TN05-2023
Master of Science - Nursing
Vanderbilt University School of Nursing
Nashville, TN01.2011
Associate Degree - Nursing
Aquinas College
Nashville, TN01.2004
Undergraduate Courses -
Tennessee State University
01.1998
Undergraduate Courses -
Troy State University
Ft. Walton Beach, FL01.1993
Skills
- Utilization management
- Regulatory compliance
- Performance metrics
- Data analytics
- Policy development
- Project management
- Performance reporting
- Workforce management
Certification
- Family Nurse Practitioner, American Nurses Credentialing Center, 05/01/11 - present
- Basic Life Support, American Heart Association, 05/01/02 - present
- Advanced Practice Registered Nurse, 05/01/11 - present
- Tennessee Registered Nursing, 05/01/04 - present
- InterQual Instructor Certification
- MCG Certification
Awards
1996, Golden Key National Honor Society, Tennessee State University
Continuing Education
- 2021, Continuing Medical Education 24.0 hours, 3.0 Pharmacology hours
- 2020, Continuing Medical Education 8.0 hours, 3.0 Pharmacology hours
- 2019, Continuing Medical Education 20.0 hours, 25.0 Pharmacology hours
- 2018, Continuing Medical Education 2.0 Pharmacology hours
- 2017, Continuing Medical Education 2.0 Pharmacology hours
- 2016, Continuing Medical Education 75.0 hours, 25.0 Pharmacology hours
- 2013, International Society of Heart and Lung Transplant conference Montreal, Quebec
- 2011, Unnatural causes presentation 04/21/11 3.0 continuing education hours Vanderbilt University Medical Center Nashville, Tennessee
Memberships And Philanthropy
- American Association of Nurse Practitioners, 2019 - Present
- Native American Indian Association of Tennessee, 2019 - Present
- International Society of Heart and Lung Transplant, 2013 - 2014
- American Academy Critical Care Nurses, 2006 - Present
- American Burn Association, 2004 - 2019
References
References available upon request.
Timeline
Regional Hospitals Utilization Management Manager
Vanderbilt University Hospital
01.2023 - Current
Utilization Management Specialist
Vanderbilt Utilization Medical Center
05.2021 - 12.2022
Nurse Practitioner, Clinic Lead
Vanderbilt Burn Clinic
06.2014 - 04.2021
Lung Transplant Coordinator
Vanderbilt Lung Transplant
03.2012 - 06.2014
RN-II, Team Leader, Preceptor, Staff Nurse
Regional Burn Center
05.2004 - 02.2012
Doctorate of Nursing Practice - Nursing
Vanderbilt University School of Nursing
Master of Science - Nursing
Vanderbilt University School of Nursing
Associate Degree - Nursing
Aquinas College
Undergraduate Courses -
Tennessee State University
Undergraduate Courses -
Troy State University
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