Kimberly Wiley
Lake Cormorant,MS
Summary
Dedicated Utilization Review Nurse Case Manager with expertise in insurance coordination and patient assessment. Proven ability to enhance patient care while ensuring compliance with clinical standards and insurance guidelines.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse Case Manager
LeBonheur Children' Medical Center
Memphis, TN
12.2014 - 09.2025
- Reviewed patient records for compliance with insurance guidelines and clinical standards.
- Collaborated with healthcare teams to streamline patient care and optimize resource utilization.
- 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.
Case Manager
AR Children's Hospital
Little Rock, AR
07.2012 - 11.2014
- Facilitated communication among interdisciplinary teams to ensure holistic client support and care.
- Identified barriers to care and developed strategies to overcome obstacles faced by clients.
- Facilitated communication between clients, families, caregivers, social services and other agencies to ensure client needs were met.
Education
Bachelor of Science - Nursing
University of Arkansas Medical Sciences
05-2004
Bachelor of Science - Elementary Education
Florida State University
05-1993
Skills
- Utilization review
- Patient assessment
- Case management
- Insurance coordination
- Interdisciplinary collaboration
- Effective communication
- Critical thinking
- InterQual criteria
- HIPAA compliance
- Prior authorization
- Milliman guidelines
Certification
- Accredited Case Manager certification from ACMA
- Currently hold a compact nursing license (NLC) from the state of MS
- Registered Nursing License
References
References available upon request.
Education and Training
other,other
Timeline
Utilization Review Nurse Case Manager
LeBonheur Children' Medical Center
12.2014 - 09.2025
Case Manager
AR Children's Hospital
07.2012 - 11.2014
Bachelor of Science - Nursing
University of Arkansas Medical Sciences
Bachelor of Science - Elementary Education
Florida State University