Mallory Walls
Burleson,TX
Summary
Dedicated and driven Texas State Board-Certified Registered Nurse with over 17 years of experience delivering high-quality care to patients in a clinical care setting. Currently, in the utilization management care space for review, collaboration, management, and member disease management. Seeking a position that will continue to build my excellent nursing career, I am committed to advancing nursing practice and improving patient health outcomes through critical thinking and teamwork.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Primary Nurse Case Administrator I UM
HCSC, Blue Cross Blue Shield of Texas
Richardson, Texas
12.2022 - Current
- Conducts comprehensive medical record reviews to evaluate medical necessity, appropriateness of care, and alignment with MCG evidence-based practice guidelines.
- Collaborates with physicians, case managers, and medical directors to ensure timely authorizations, and optimize patient care pathways.
- Applies clinical knowledge and Milliman Care Guidelines to determine medical necessity for inpatient, outpatient, and specialty care services.
- Documents findings clearly and accurately in compliance with regulatory, accreditation, and HIPAA requirements.
- Identifies opportunities for cost savings, reduced length of stay, and improved patient outcomes with timely discharge planning, while maintaining quality of care.
- Maintained >98% audit accuracy rate across all utilization review activities proof of providing quality
Registered Nurse, PACU, NICU
Cook Children's Medical Center
Fort Worth, TX
10.2011 - 12.2022
- Charge nurse
- Preop to prepare patients and families to have surgery
- Monitor PACU patients
- Maintain and manage intubated patients, and perform extubation
- PACU care management
- Chart Audit Committee
- Teamwork/Communication & Scheduling Committee
- IRB Research Team-Consent families for participation in EBP research studies
- Circulate patient cases in procedures while managing patient care along side physician
- Extensive knowledge base with disease management in Gastroenterology, Oncology, Radiology, Audiology, and Wound Care
- Delivers outstanding care to patients with various diagnosis and managed care from treatment initiation through to completion
Newborn Nursery/NICU Registered Nurse
Texas Health Resources Harris Southwest Hospital
Fort Worth, TX
10.2010 - 10.2011
- Continuously monitor and manage critically ill and hight acuity newborns
- Collaborate with families, physicians and other medical staff to provide the best care to patients
- Perform a wide arrange of skills including IVs, foley catheters, placing feeding tubes, and manage ventilators
- Monitored patient condition while updating appropriate team members on changes in stability and acuity
RN Hospice Case Manager
Tender Heart Hospice
Fort Worth, TX
05.2009 - 09.2010
- Developed patient care plans, overall patient health assessments and evaluations.
- Collaborated with physicians on patient medications, medical needs and performance.
- Determined and coordinated appropriate level of care to meet individual patient needs.
- Performs and completes an initial, comprehensive, and ongoing assessments of patient and family to determine hospice needs.
- Creates, organizes, and manages individualized patient care plan to meet the needs of the patient, ensuring all services are identified and met.
- Provides advice and emotional support to patients and their family members.
- Supervises Health Aide and LVNs in providing care to patients.
- Educates patients and family about health maintenance and disease prevention.
- Attended regularly the IDG meeting to discuss the condition of the patient.
Education
Bachelor of Science - Nursing
Tarleton State University
Stephenville, TX12.2008
Skills
- 17 years of clinical/administrative RN practice
- High level of autonomy
- Critical Thinking and Assessment Overview
- Utilization Management Review
- Case Management
- Charge Nurse Role
- Milliman (MCG) Evidence-based guidelines
- Prep/Recovery perioperative services
- Pediatric disease management plans
- Computer skills including word, excel, one note
- Computer charting EPIC and WEBMRE, Premiere
- SBAR communication
- Hospice palliative and pain management
- Patient satisfaction and process improvement
- Cost effective role documenting charges
- Care coordination, Patient education, Disease management & Quality improvement
- Research proficiency
- Home hospice visits
Certification
- Registered Nurse License 770700
Timeline
Primary Nurse Case Administrator I UM
HCSC, Blue Cross Blue Shield of Texas
12.2022 - Current
Registered Nurse, PACU, NICU
Cook Children's Medical Center
10.2011 - 12.2022
Newborn Nursery/NICU Registered Nurse
Texas Health Resources Harris Southwest Hospital
10.2010 - 10.2011
RN Hospice Case Manager
Tender Heart Hospice
05.2009 - 09.2010
Bachelor of Science - Nursing
Tarleton State University
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