Juliane Boyd
Maryville,TN
Summary
Dynamic Utilization Review Specialist with a proven track record at Cornerstone of Recovery, adept at enhancing patient outcomes through effective discharge planning and compliance with healthcare regulations. Skilled in documentation and reporting, I excel in critical thinking and teamwork, ensuring optimal care while minimizing hospital readmissions.
Professional in healthcare management, equipped with strong background in coordinating and optimizing patient care. Skilled in conducting thorough reviews of medical records and collaborating with healthcare teams to ensure compliance with standards. Highly adaptable, reliable, and focused on achieving measurable outcomes. Proven ability to navigate complex healthcare systems and support continuous improvement initiatives.
Dependable Utilization Review Specialist promoting over 13 years of expertise in healthcare industry. Knowledgeable in admissions and stay reviews.
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level Utilization Review Director position. Ready to help team achieve company goals.
Overview
13
13
years of professional experience
1
1
Certificate
Work History
Utilization Review Specialist
CORNERSTONE OF RECOVERY
03.2012 - Current
- Collaborated with interdisciplinary teams to create effective discharge plans that promoted optimal patient outcomes while minimizing hospital readmissions.
- Identified trends in healthcare usage among patients, providing valuable insights to inform strategic planning efforts within the organization.
- Proactively addressed potential barriers to care during the review process, connecting patients with appropriate resources such as financial assistance programs or support groups.
- Provided timely feedback to physicians regarding patient progress, facilitating adjustments to treatment plans as needed.
- Promoted patient satisfaction through careful attention to individual needs during the review process, addressing concerns promptly and professionally.
- Evaluated new protocols or interventions for cost-effectiveness and clinical utility, supporting evidence-based decision-making within the organization.
- Participated in ongoing professional development opportunities to stay current with trends and best practices in utilization review, bringing new insights back to the organization.
- Assisted with audits to ensure compliance with federal regulations governing Medicare and Medicaid reimbursements, safeguarding against potential penalties or sanctions from government agencies.
- Managed a high volume of cases efficiently by prioritizing tasks and maintaining strict deadlines for completion of reviews.
- Demonstrated strong analytical skills by interpreting complex medical records and synthesizing relevant information for utilization review purposes.
- Enhanced patient care by conducting thorough utilization reviews and ensuring adherence to treatment plans.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Performed prior authorization review of services requiring notification.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Performed admission reviews based for medical necessity based upon ASAM/MCG GUIDELINES specification.
- Devise or identify solutions for irregular requests and issues.
- Evaluated patient histories, complaints, and current symptoms.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Provided skilled, timely and level-headed emergency response to critically-ill patients.
- Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
- Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
- Recorded details regarding therapies to keep patient charts updated.
- Collaborated with leadership to devise initiatives for improving nursing satisfaction, retention and morale.
- Participated in evidence-based practice project implementation, nursing competency development and nursing simulation activities.
Education
LADAC I, NCAC I - LICENSED ALCOHOL/DRUG COUNSELOR
CORNERSTONE OF RECOVERY
Louisville, TN11-2021
GED -
EVERETT ADULT HIGH SCHOOL
MARYVILLE TN03-2011
Skills
- HIPAA compliance
- Quality improvement
- Healthcare regulations
- Medicare compliance
- Utilization management
- Documentation and reporting
- Inpatient care
- Discharge planning
- Utilization review
- Patient care plans
- Medical necessity criteria
- Private insurance policies
- Discharge planning coordination
- Clinical assessment
- Insurance verification
- Records analysis
- Needs assessment
- Physician consultations
- Performing assessments
- Communication
- Patient transfers and transitions
- Plan of care support
- Compliance procedures
- Teamwork
- Problem-solving
- Time management
- Attention to detail
- Multitasking
- Compassionate and caring
- Multitasking Abilities
- Reliability
- Excellent communication
- Critical thinking
- Strong clinical judgment
- Direct patient care
- Organizational skills
- Team collaboration
- Active listening
- Effective communication
- Adaptability and flexibility
- Creative problem solving
- Decision-making
- Patient and family advocacy
- Patient care assessment
- Clinical documentation
- Relationship building
- Vitals monitoring
- Microsoft office
- Team building
- Safety protocols
- Delegation and motivation
- Task prioritization
- Patient condition monitoring
- Self motivation
- Interpersonal communication
- Professionalism
- Goal setting
- Patient advocacy
- Training staff
Accomplishments
- Documented and resolved clinicals documentation which leds to denials.
- trained other facilities to work with Ambetter insurance.
- work well in diversity.
- Achieved overturned denials by completing doc/peer reviews tasks with accuracy and efficiency.
Timeline
Utilization Review Specialist
CORNERSTONE OF RECOVERY
03.2012 - Current
LADAC I, NCAC I - LICENSED ALCOHOL/DRUG COUNSELOR
CORNERSTONE OF RECOVERY
GED -
EVERETT ADULT HIGH SCHOOL
INDIRECT EMPLOYEE OF THE YEAR, CORE VALUES AWARD MY FIRST YEAR HERE.
I received the indirect employee of the year award in 2024, not my first year. I was so surprised and grateful to receive it. It means a lot to be noticed by your company. I have dedicated my life to helping this job. I take pride in my work and I would be honored to be the UR Director for COR. That being said, I know I am not perfect, but I know that I could do this job. I love my job and I would love the chance to take on this role.
In 2013, I got the Core Vales award at COR my first year, because I showed integrity, respect for the individual, teamwork, innovation, and continuous improvement, honest communication, leadership, and flexibility.
I care about the still suffering addict. I know that I just have my LADAC/NCAC I, but I have tons of experience at COR in this field. I am teachable and love a challenge. I am a problem solver and will do everything in my power to get days covered.
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