Jennifer Suderman
Chico,CA
Summary
Proven leader in healthcare management, adept at orchestrating the implementation of cutting-edge UR screening tools at Enloe Health, enhancing operational efficiency and team performance. Excelled in project management and coaching, significantly improving process outcomes and staff skill sets. Demonstrated expertise in regulatory compliance and performance improvement, driving forward departmental goals with strategic vision and mentorship.
Overview
18
18
years of professional experience
Work History
Utilization Review/Denials Team Lead
Enloe Health
09.2021 - Current
- Managed schedules, accepted time off requests and found coverage for short shifts.
- Trained new team members by relaying information on company policies and procedures and department specific education.
- Evaluated employee skills and knowledge regularly, training, and mentoring individuals with lagging skills, to include annual evaluations.
- Assisted in recruitment and hiring process
- Orchestrated implementation of 2 new UR screening tools (InterQual AutoReview and MCG ICM/IAD).
- Communicated KPIs outlined in UM Committee to inform upper leadership of the progress of the department as well as goals moving forward.
- Devised and implemented processes and procedures to improve and streamline operations.
- Evaluated staff performance and provided coaching to address inefficiencies. Implemented and carried out performance improvement plans as needed.
Utilization Review Nurse
Enloe Health
05.2019 - 09.2021
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Submitted cases for secondary physician review for criteria failures to help facilitate resolutions and approvals.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Served as subject matter resource, providing information to Providers, Billers, Insurance Verification and Case Management.
- Performed admission reviews based for medical necessity.
- Conducted ongoing concurrent reviews, and updated payors with current information.
- Collaborated with leadership to devise initiatives for improving the quality of our reviews.
- Learned payor behaviors and pivoted to payor-specific workflow processes based on new knowledge.
Case Manager (RN Care Coordinator)
Enloe Medical Center
10.2017 - 05.2019
- Partnered with physicians, social workers, therapists, nutritionists, and case managers to develop and implement individualized discharge plans and documented patient interactions and interventions in electronic health records.
- Coordinated services with other agencies, community-based organizations, and healthcare professionals to create safe discharge plans.
- Assessed patients for discharge planning needs and designed discharge plans that met the patients' needs.
- Monitored patients' progress to determine most appropriate discharge plan at time of discharge to include facilitating transfers to higher level of care.
Nurse Navigator (Breast Imaging)
North State Radiology
12.2011 - 09.2017
- Facilitated timely scheduling of appointments, diagnostic testing and procedures to advocate for patients, expedite plan of care and promote continuity.
- Assessed and identified high risk patients using screening tools. Communicated findings to Radiologists to determine appropriate cadence of follow up appointments.
- Documented post-procedure pathology findings in patients' electronic health records.
- Compiled data and tracked outcomes to formulate recommendations for process improvement.
- Created/Updated all RN related workflow processes pertaining to diagnostic testing and procedures.
- Communicated biopsy results to patients and coordinated follow up appointments with Breast Surgery/ Oncology.
- Maintained annual Center of Excellence certification through National Consortium of Breast Centers (NCBC).
- Project managed/coordinated mammogram days for underserved groups in the community.
- Provided ongoing education to patients and providers in the community.
Registered Nurse
Enloe Health
06.2006 - 08.2011
- Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use, and disease management.
- Managed quality care for patients with heart failure, end-stage renal disease and coronary artery disease.
- Served as Team Leader, assisting with conscious sedation procedures and support for staff.
- Served as relief Charge Nurse, creating staff assignments and coordinating admissions/discharges.
- Served as super user for the implementation of a new electronic health record system (MediTech).
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Documented assessments, treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
Education
Associate of Science - Registered Nursing
Butte Community College
OrovilleBachelor of Science - Registered Nursing
Western Governors University
05.2020
Skills
- Productivity Monitoring
- Trend tracking
- Performance monitoring
- Schedule Management
- Performance Improvement
- Coaching and Mentoring
- Employee Evaluation
- Complaint resolution
- Regulatory Compliance
- Project Management
Timeline
Utilization Review/Denials Team Lead
Enloe Health
09.2021 - Current
Utilization Review Nurse
Enloe Health
05.2019 - 09.2021
Case Manager (RN Care Coordinator)
Enloe Medical Center
10.2017 - 05.2019
Nurse Navigator (Breast Imaging)
North State Radiology
12.2011 - 09.2017
Registered Nurse
Enloe Health
06.2006 - 08.2011
Associate of Science - Registered Nursing
Butte Community College
Bachelor of Science - Registered Nursing
Western Governors University
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