Jodee Rapp
Cunningham,TN
Summary
Registered Nurse with extensive healthcare experience in utilization management and clinical operations. Demonstrates leadership in developing efficient workflows, ensuring regulatory compliance, and analyzing performance metrics to drive measurable outcomes. Recognized for fostering collaboration and continuous improvement within fast-paced healthcare environments.
Overview
1
1
Certification
20
20
years of professional experience
Work History
Clinical Program Consultant
Optum Health
10.2024 - Current
- Lead development and implementation of utilization management procedures and workflows that improve operational efficiency, consistency, quality, and regulatory compliance.
- Partner with cross-functional stakeholders and subject matter experts to evaluate current-state processes and identify opportunities for process standardization and optimization.
- Analyze operational and clinical data to identify trends, root causes, performance gaps, and improvement opportunities, translating findings into actionable recommendations.
- Design and conduct targeted audits to evaluate documentation quality, workflow adherence, and compliance with established policies and procedures.
- Develop training materials, work instructions, and educational resources to support clinician performance and operational consistency.
- Support change initiatives through stakeholder engagement, communication, and implementation planning.
- Collaborate with leaders across clinical operations to resolve barriers, improve outcomes, and drive process improvements.
Clinical Team Manager
Optum Health
11.2021 - 10.2024
- Managed and developed a team of utilization management clinicians, providing leadership, coaching, performance management, and professional development.
- Monitored operational performance, quality metrics, productivity standards, turnaround times, and service-level expectations to ensure achievement of business objectives.
- Conducted performance reviews and quality audits, identifying trends and implementing corrective actions to improve outcomes.
- Led process improvement initiatives that increased operational effectiveness and reduced workflow variation.
- Facilitated communication between operational leaders and frontline staff to support organizational change and process adoption.
- Fostered a culture of accountability, collaboration, engagement, and continuous improvement.
Pre-Service Clinical Reviewer
Optum Health
04.2017 - 12.2021
- Performed comprehensive prior authorization reviews to determine medical necessity using established clinical criteria and evidence-based guidelines.
- Maintained compliance with regulatory, accreditation, and organizational requirements while meeting productivity and turnaround time expectations.
- Collaborated with providers and healthcare professionals to ensure appropriate care decisions and optimize member outcomes.
- Managed large caseloads while maintaining documentation accuracy and audit readiness.
- Supported operational excellence through consistent application of utilization management policies and procedures.
Registered Nurse, Nurse Reviewer
EviCore Healthcare
Franklin, USA
12.2012 - 04.2017
- Conducted utilization management reviews for radiology and specialty services, ensuring adherence to clinical guidelines, CMS requirements, and URAC standards.
- Served as a resource for health plan representatives and providers regarding authorization decisions, appeals, and clinical review processes.
- Participated in development and enhancement of nursing protocols, workflows, policies, and communication standards.
- Managed complex authorization requests while maintaining quality standards and service expectations.
- Collaborated across departments to improve operational consistency and customer experience.
Registered Nurse, Cardiac Telemetry
Saint Thomas Hospital
Nashville, USA
05.2006 - 12.2012
- Served as Charge Nurse for a 23-bed telemetry unit, coordinating patient care delivery and clinical operations.
- Functioned as a nurse preceptor, training and mentoring staff and new team members.
- Participated on hospital committees focused on quality improvement and operational initiatives.
- Collaborated with interdisciplinary teams to coordinate treatment plans and discharge planning.
Clinical Nursing Instructor
Aquinas College School of Nursing
01.2011 - 01.2012
- Educated and supervised nursing students in laboratory and clinical settings.
- Evaluated student performance and clinical competencies.
- Collaborated with academic and healthcare stakeholders to optimize clinical learning experiences.
Education
Bachelor of Science in Nursing -
Austin Peay State University
Clarksville, TNSkills
- Utilization Management Operations
- Clinical Process Improvement
- Root Cause Analysis & Corrective Actions
- Regulatory & Accreditation Compliance (CMS)
- Clinical Quality & Auditing
- Performance Monitoring & SLA Achievement
- Workflow Design & Optimization
- Policy, Procedure & Work Instruction Development
- Data Analysis & Reporting
- Change Management
- Cross-Functional Collaboration
- Clinical Training & Education
- Leadership & Team Development
- Process Standardization
- Continuous Improvement
- Effective communication
Certification
Registered Nurse (RN), Tennessee
Degree
BSN, RN
Additional Qualifications
- Active RN license with extensive utilization management experience.
- More than 10 years supporting prior authorization and clinical operations functions.
- Experienced in process improvement, workflow optimization, quality auditing, and clinician education.
- Advanced user of Microsoft Excel, PowerPoint, and operational reporting tools.
- Proven ability to influence stakeholders, lead change initiatives, and achieve operational outcomes in complex healthcare environments.
Timeline
Clinical Program Consultant
Optum Health
10.2024 - Current
Clinical Team Manager
Optum Health
11.2021 - 10.2024
Pre-Service Clinical Reviewer
Optum Health
04.2017 - 12.2021
Registered Nurse, Nurse Reviewer
EviCore Healthcare
12.2012 - 04.2017
Clinical Nursing Instructor
Aquinas College School of Nursing
01.2011 - 01.2012
Registered Nurse, Cardiac Telemetry
Saint Thomas Hospital
05.2006 - 12.2012
Bachelor of Science in Nursing -
Austin Peay State University