Letitia Hickly
Pittsburgh,PA
Summary
Dedicated and experienced Case Manager adept at handling high caseloads without sacrificing quality of care. Operates in high-pressure environments while recommending best resources and courses of action to benefit patient needs and return each to optimal quality of life.
Overview
19
19
years of professional experience
Work History
REGISTERED NURSE, OUTPATIENT SURGERY
ST. CLAIR HOSPITAL
08.2022 - Current
- Responsible for planning, organizing, and directing patient care in accordance with established standards and skill competency in a busy Outpatient Surgery Unit.
SENIOR PROFESSIONAL CARE MANAGER
UPMC SHADYSIDE HOSPITAL
04.2017 - 08.2022
- Reviewed medical record daily to ensure patient continues to meet LOC requirements and that chart documentation supports LOC determination.
- Collaborated with patients, caregivers, internal/external healthcare providers, agencies, and payers to plan and execute a safe discharge.
- Served as a resource to clinical and finance teams for clinical documentation requirements, level of care, insurance coverage issues, specific payer and government policies and post-acute service coverage and availability.
- Started discharge planning on admission and ensures discharge documentation is completed and updated regularly.
UTILIZATION REVIEW NURSE
HIGHMARK HEALTH
09.2015 - 04.2017
- Served as a liaison between care managers, and payors and facilitated payer/physician contact when indicated.
- Communicated to the Medical Directors, Attending Physicians and/or CFO, if indicated, regarding evaluation of medical appropriateness.
- Maintained current knowledge of regulatory guidelines related to authorizations
- Performed clinical review for cases requiring authorization or adherence to payor medical policies.
REGISTERED NURSE, GI LAB
ST. CLAIR HOSPITAL
09.2012 - 09.2015
- Administered conscious sedation and monitoring during GI procedures
- Responsible for Pre and post care for GI procedure patients in an outpatient setting.
- Reduced hospital readmissions through effective discharge planning, patient education, and follow-up care coordination.
REGISTERED NURSE, INFUSION CENTER
ST. CLAIR HOSPITAL
09.2010 - 09.2012
- Responsible for administration of blood products, chemotherapy, and a wide variety of infusions in an outpatient setting and difficulty IV restarts and PICC insertions within the hospital
REGISTERED NURSE, CORONARY CARE UNIT
ST. CLAIR HOSPITAL
01.2006 - 09.2010
- Provided direct patient care on a 20-bed coronary care unit.
PRIOR AUTHORIZATION NURSE
CIGNA HEALTHCARE
06.2005 - 01.2006
- Responsible for approving a variety of inpatient and outpatient procedures.
Education
Bachelor Of Science - Nursing
Indiana University of Pennsylvania
Indiana, PA05.1995
Skills
- Disease management
- Patient Discharging
- Care Plan Development
- Complex Problem-Solving
- Strong Clinical Judgment
- Team Coordination
- Patient Care Planning
- Intakes and Discharges
- Patient Assessments
- IV Drug Therapy Management
- Patient Care
- Health Insurance Experience
Timeline
REGISTERED NURSE, OUTPATIENT SURGERY
ST. CLAIR HOSPITAL
08.2022 - Current
SENIOR PROFESSIONAL CARE MANAGER
UPMC SHADYSIDE HOSPITAL
04.2017 - 08.2022
UTILIZATION REVIEW NURSE
HIGHMARK HEALTH
09.2015 - 04.2017
REGISTERED NURSE, GI LAB
ST. CLAIR HOSPITAL
09.2012 - 09.2015
REGISTERED NURSE, INFUSION CENTER
ST. CLAIR HOSPITAL
09.2010 - 09.2012
REGISTERED NURSE, CORONARY CARE UNIT
ST. CLAIR HOSPITAL
01.2006 - 09.2010
PRIOR AUTHORIZATION NURSE
CIGNA HEALTHCARE
06.2005 - 01.2006
Bachelor Of Science - Nursing
Indiana University of Pennsylvania