Lori Smith
Bonaire,GA
Summary
Dynamic Senior Case Management Nurse with a proven track record at Sonder Health Plans, excelling in telephonic case management and interdisciplinary collaboration. Achieved over 95% compliance in audits while developing member-centered care plans. Skilled in training and mentoring, ensuring operational efficiency and quality assurance in patient care processes. Chronic care management.
Overview
30
30
years of professional experience
Work History
Senior Case Management Nurse
Sonder Health Plans
Atlanta, Georgia
03.2023 - Current
- Provided leadership for and presented during Integrated Care Team meetings and member rounds, ensuring a coordinated approach to patient care.
- Conducted regular audits to ensure a high level of data entry and integrity, maintaining accuracy and attention to detail.
- Provided training and support for new team members and continued training for existing members, assisting in the use of new software and technologies.
- Collaborated with and coordinated services and supports between PCPs, specialists, medical, behavioral, and community service providers to meet the complete medical and social needs of members.
- Developed, assessed, and adjusted care plans to promote quality, member-centered, and cost-effective care for a diverse caseload.
Workers' Compensation Utilization Review Nurse (Contract)
Intelligent Medical Solutions Managed Care
Lake Forest, California
11.2022 - 02.2023
- Balanced quality of care with cost efficiency by performing telephonic Utilization Review.
- Compiled and reviewed medical information and insurance coverage, certified requested medical services, and prepared cases for physician review.
Worker's Compensation Nurse Case Manager (Contract)
Managed Care Advisors
Bethesda, Maryland
03.2022 - 10.2022
- Performed telephonic case management activities in accordance with management standards.
- Served as a 3-point contact on new cases and forwarded files within 24 to 72 hours of referral.
- Completed monthly reports and provided 24-hour updates after every significant activity.
Nurse Case Manager
Piedmont HealthCare
Macon, Georgia
10.2020 - 03.2022
- Successfully conducted Case Management Utilization Reviews for over 40 patients, maintaining Milliman and InterQual standards.
- Consolidated an audit score of over 95% for compliance with internal documentation and industry’s best practices.
- Assessed and developed robust care plans focused on patient care needs, disease management, and treatment alternatives.
Nurse Case Manager
Three Rivers Home Health
Warner Robins, Georgia
10.2019 - 10.2020
- Provided patient education on healthcare plans, including Medicaid and Medicare, to empower patients and families for a sustained recovery.
- Assessed patient needs and developed customized home healthcare plans.
Patient Care Manager/Case Manager
Hospice Care Options
Warner Robins, Georgia
10.2014 - 10.2019
- Supervised and mentored a team of 20 staff members.
- Served as the lead instructor for a new EMR system, ensuring a seamless transition and operational efficiency.
- Coordinated with Medicare and other insurance companies to effectively manage patient care processes.
Education
Bachelor of Science - Nursing
Chamberlain College of Nursing
Illinois, United StatesAssociate of Science - Nursing
Madisonville Community College
Kentucky, United StatesCertificate - Utilization Review
Marie Peppers Remote Nurse Course UR 101
Skills
- Telephonic Case Management
- Utilization Review
- Concurrent Review
- Prior Authorizations
- InterQual
- Milliman
- Patient and Family Advocacy
- HEDIS Nursing
- Critical Care
- Infection Control
- Patient Consultation
- Care Plan Development
- ICD Coding
- Documentation & Reporting
- Quality Assurance
- Interdisciplinary Collaboration
- Medical Management Systems
- Training & Mentoring
- Process Improvement
- Administrative Work
- Stakeholder Communication
Licenses And Affiliations
- Compact Nursing License, eNLC
- Georgia Nursing License
- American Nurse Association
Areas Of Expertise
Telephonic Case Management, Utilization Review, Concurrent Review, Prior Authorizations, InterQual, Milliman, Chronic Care Management Patient and Family Advocacy, HEDIS Nursing, Critical Care, Infection Control, Patient Consultation, Care Plan Development, ICD Coding, Documentation & Reporting, Quality Assurance, Interdisciplinary Collaboration, Medical Management Systems, Training & Mentoring, Process Improvement, Administrative Work, Stakeholder Communication
Timeline
Senior Case Management Nurse
Sonder Health Plans
03.2023 - Current
Workers' Compensation Utilization Review Nurse (Contract)
Intelligent Medical Solutions Managed Care
11.2022 - 02.2023
Worker's Compensation Nurse Case Manager (Contract)
Managed Care Advisors
03.2022 - 10.2022
Nurse Case Manager
Piedmont HealthCare
10.2020 - 03.2022
Nurse Case Manager
Three Rivers Home Health
10.2019 - 10.2020
Patient Care Manager/Case Manager
Hospice Care Options
10.2014 - 10.2019
Bachelor of Science - Nursing
Chamberlain College of Nursing
Associate of Science - Nursing
Madisonville Community College
Certificate - Utilization Review
Marie Peppers Remote Nurse Course UR 101
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