Lori Oletta, BSN RN CCM
Virginia Beach,Virginia
Summary
Hands-on professional proudly offering more than 10 years of expertise in nursing field. Well-rounded and personable Utilization Review Nurse talented in reporting, records oversight and performance improvement.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Utilization Management, Registered Nurse
Molina Healthcare
01.2022 - 12.2023
- Strengthened quality improvement initiatives through regular audits of utilization review processes, identifying areas for improvement, and implementing corrective actions.
- Assisted in maintaining regulatory compliance by staying up-to-date on Virginia Medicaid requirements for utilization review activities.
- Collaborated with physicians to develop appropriate care plans based on utilization review findings that were both medically necessary and cost effective.
- Provided accurate documentation of all utilization review findings, ensuring clear audit trail for future reference or analysis.
- Promoted interdepartmental collaboration to streamline workflow processes, resulting in improved efficiency and patient outcomes.
RN Case Manager and Utilization Review
Chesapeake Regional Hospital
08.2021 - 12.2021
- Provided emotional support to patients coping with chronic illness or end-of-life decisions, fostering resilience during difficult times.
- Managed two ICU's with complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
- Collaborated closely with physicians to develop individualized treatment plans, supporting optimal patient outcomes.
- Educated patients and families on available community resources, facilitating access to necessary support services.
- Served as key liaison between patients, families, and healthcare providers, fostering open communication and trust among all parties involved in care process.
Prior Authorization Manager
Sentara Healthcare
03.2018 - 03.2021
- Managed and motivated 60 employees to be productive and engaged in work.
- Maintained professional, organized, and safe environment for employees and patrons.
- Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
- Maximized performance by monitoring daily activities and mentoring team members.
- Onboarded new employees with training and new hire documentation.
- Cross-trained existing employees to maximize team agility and performance.
- Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
- Monitored and analyzed business performance to identify areas of improvement and make necessary adjustments.
- Achieved departmental goals by developing and executing strategic plans and performance metrics.
Education
Bachelor of Science - Nursing
Sentara College of Health Sciences
Chesapeake, VA12.2014
Associate of Science - Nursing
Greenville Technical College
Greenville, SC12.2008
Associate of Arts - Art
Greenville Technical College
Greenville, SC08.2006
Skills
- Patient confidentiality
- Medical Documentation
- Clinical assessment
- Quality Improvement
- HIPAA Compliance
- Healthcare regulations
- Documentation And Reporting
- Discharge planning coordination
- Medicare knowledge
- Utilization Management
- Critical Thinking
- Utilization review
Certification
- Registered Nurse, Virginia Compact License: Number: 0001217893 - 01/2008 to 04/30/2026
- Certified Case Manager (CCM), The Commission for Case Management - Certification Number: 4206248 - 01/01/2014 to 12/30/2028
Timeline
Utilization Management, Registered Nurse
Molina Healthcare
01.2022 - 12.2023
RN Case Manager and Utilization Review
Chesapeake Regional Hospital
08.2021 - 12.2021
Prior Authorization Manager
Sentara Healthcare
03.2018 - 03.2021
Bachelor of Science - Nursing
Sentara College of Health Sciences
Associate of Science - Nursing
Greenville Technical College
Associate of Arts - Art
Greenville Technical College