Lauren Stokes
Wildwood,MO
Summary
Organized team leader builds positive rapport, inspires trust and guides teams toward achievement of organizational goals. Strong facilitator adept at working cross-departmentally with co-management and top-level leadership. Excellent trainer and mentor. Experience working with multiple managed Medicaid plans and departments, including Prior Auth, Concurrent Review and Post-Acute. Clinical experience in Telemetry, Med-Surg and Emergency Department.
Overview
10
10
years of professional experience
1
1
Certification
Work History
UM, Medicaid Post-Acute Team Lead
Aetna Better Health Medicaid Centralized Team
2022.11 - Current
- Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facility appropriate LOC post-acute inpatient stays
- Analyzes reports for assignments, trends, issues and ensuring turnaround times are met
- Assists with escalated case reviews/facility issues
- Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
- Assist with managing 13 nurses on the team
- Assists with questions from frontline staff on cases.
- Trained new team members by relaying information on company procedures and contractual agreements
- Promoted a positive work environment by fostering teamwork and open communication
UM Clinical Consultant, Concurrent Review Nurse
Aetna Better Health of Pennsylvania
2017.06 - 2022.11
- Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members
- Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care
- Communicates with providers and other parties to facilitate care/treatment
- Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
- Mentored new nursing staff members, fostering teamwork while meeting contractual TAT requirements
UM Clinical Consultant, Prior Authorization Nurse
Aetna Better Health of Missouri
2016.06 - 2017.05
- Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members
- Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care
- Communicates with providers and other parties to facilitate care/treatment
- Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.
Emergency Department Registered Nurse
SSM St. Joseph Health Center
2016.01 - 2017.05
- Perform emergency medical procedures, such as basic cardiac life support (BLS), advanced cardiac life support (ACLS), and other conditions stabilizing interventions
- Manage patients' pain relief and sedation by providing pharmacologic and nonpharmacologic interventions, monitoring patients' responses, and changing care-plans accordingly
- Document data related to patients' care including assessment results, interventions, medications, patient responses, or treatment changes
- Administer blood and blood product transfusions or intravenous infusions, monitoring patients for adverse reactions.
Ortho Med-Surg Registered Nurse
Tristar Greenview Medical Center
2015.06 - 2016.01
Telemetry Registered Nurse
Centinela Hospital Medical Center
2014.12 - 2015.04
- Maintain accurate, detailed reports and records
- Administer medications to patients and monitor patients for reactions or side effects
- Consult and coordinate with healthcare team members to assess, plan, implement, or evaluate patient care plans
- Modify patient treatment plans as indicated by patients’ responses and conditions.
Education
Bachelor of Science in Nursing -
Missouri State University
Springfield, MO12.2016
Associate of Applied Sciences -
St. Louis Community College
St. Louis, MO05.2014
Associate of Arts -
St. Louis Community College
St. Louis, MO05.2013
Certificate of Surgical Technology -
St. Louis Community College
St. Louis, MO07.2011
Some College (No Degree) -
Lindenwood University
St. Charles, MOSome College (No Degree) -
Study Abroad – Canterbury Christ Church University
Canterbury, EnglandSkills
- Performance Improvement
- Teamwork and Collaboration
- Attention to Detail
- Utilization Management
- Task Delegation
- Multitasking and Organization
- Utilization review
- Microsoft 365, Word, and Excel
Certification
Registered Nurse, Missouri State Board of Nursing, 2014026081, 2014-Present
Extracurricular Activities
Student Nurse Internship, SSM St. Joseph’s Health Center ICU, St. Charles, MO, 2012
Student Nurse Internship, SSM St. Joseph’s Health Center Telemetry Floor, St. Charles, MO, 2013,
Big Sister, Big Brother Big Sisters of Eastern Missouri, St. Louis, MO, 2010-2013
Timeline
UM, Medicaid Post-Acute Team Lead
Aetna Better Health Medicaid Centralized Team
2022.11 - Current
UM Clinical Consultant, Concurrent Review Nurse
Aetna Better Health of Pennsylvania
2017.06 - 2022.11
UM Clinical Consultant, Prior Authorization Nurse
Aetna Better Health of Missouri
2016.06 - 2017.05
Emergency Department Registered Nurse
SSM St. Joseph Health Center
2016.01 - 2017.05
Ortho Med-Surg Registered Nurse
Tristar Greenview Medical Center
2015.06 - 2016.01
Telemetry Registered Nurse
Centinela Hospital Medical Center
2014.12 - 2015.04
Bachelor of Science in Nursing -
Missouri State University
Associate of Applied Sciences -
St. Louis Community College
Associate of Arts -
St. Louis Community College
Certificate of Surgical Technology -
St. Louis Community College
Some College (No Degree) -
Lindenwood University
Some College (No Degree) -
Study Abroad – Canterbury Christ Church University
Registered Nurse, Missouri State Board of Nursing, 2014026081, 2014-Present
Similar Profiles
Samantha MartzSamantha Martz
Nurse Case Manager at Aetna MedicaidNurse Case Manager at Aetna Medicaid
Shawn WinbornShawn Winborn
Medical Billing Specialist at Aetna MedicaidMedical Billing Specialist at Aetna Medicaid
Christopher (Scott) HuntChristopher (Scott) Hunt
Director Clinical Health Services at Aetna Medicaid Administrators LLCDirector Clinical Health Services at Aetna Medicaid Administrators LLC