MAMIE BELL
Simpsonville,SC
Summary
Utilization Review Nurse with extensive experience at HCA, adept in InterQual and Milliman criteria. Recent experience with an AI clinical summary tool at HCA, with knowledge of what is important to the end users, and denial prevention. Total of 16 years of CM/UM experience, with beside experience in ER, and ICU. Selected to orient new hire UM nurses at HCA corporate. In addition, I worked very closely with my CDI colleagues in ID rounding.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse
HCA Corporate (transitioned to Parallon)
Nashville, TN
01.2018 - Current
- Reviewed patient care plans for medical necessity and appropriateness.
- Analyzed patient data to support clinical decision-making processes.
- Conducted reviews of inpatient utilization for compliance with admission criteria and concurrent review requirements.
- Evaluated clinical documentation for accuracy and completeness in order to make decisions about coverage determinations.
UM/CM Nurse
Southern Hills Hospital
Las Vegas, NV
12.2015 - 01.2018
- Utilization Review and Discharge Planning for Ortho-Neuro unit.
- Orientation of new employees.
- Facilitated communication between members of the healthcare team by attending interdisciplinary meetings.
Nurse Transfer Coordinator
VA Southern Nevada Health System
North Las Vegas, NV
02.2015 - 12.2015
- Coordination of patient transfers to/from VA Southern Nevada Medical Center, Various VA Medical Centers across the United States and Non-VA Care Facilities.
- Care Coordination for veterans obtaining care at VA facilities outside of Southern Nevada.
- Care Coordination for veterans obtaining care at Non-VA Care facilities in Southern Nevada.
- Coordination of care for veterans traveling outside of Southern Nevada.
- Coordination of 120+ Interfaculty Consults.
- Recipient of Penguin Award for exemplary service chosen by VASNHS Director.
Utilization Review Nurse
Southern Hills Hospital
Las Vegas, NV
10.2014 - 02.2015
- Utilization Review for 134-bed hospital.
- Orientation of new employees to Utilization Review.
- Reviewed patient care plans for medical necessity and appropriateness.
- Developed educational materials for staff on utilization management policies.
RN Case Manager
UNC Health Care
Chapel Hill, NC
09.2012 - 10.2014
- Discharge Planning and Care Coordination for CICU, Cardiology, Heart Failure and EP service patients from across North Carolina and surrounding Virginia and South Carolina counties.
- Championed Cardiology Daily Interdisciplinary Team meetings.
- UNC Subject Matter Expect: Heart Failure Home Health, Cardiac Rehab and Pulmonary Rehab Referral education for new and current employees. As well as, maintenance of referral guidelines and polices.
- Participation in Heart & Vascular leadership meetings/Triads to help improve patient flow and throughput.
- Participation in UNC Transitions of Care/Performance Improvement program to help reduce readmission rates.
- Orientation of new employees.
CM/UM Nurse
Spring Valley Hospital Medical Center
Las Vegas, NV
10.2010 - 06.2012
- Utilization Review and Discharge Planning for Med/Surg, IMC, Psych Hold patients.
- Case Manager selected from Spring Valley Hospital to participate in the Valley Health System SNF Return to Admit Prevention Committee.
- Orientation of new employees.
- Facilitated communication between members of the healthcare team by attending interdisciplinary meetings.
Education
Bachelor of Science - Nursing
Western Carolina University
Cullowhee, NC05.2007
Skills
- InterQual and Milliman
- Midas
- Meditech, Epic, Cerner
- WellSky
- Microsoft Word, Excel, PPT, and Outlook
Title
RN BSN CCM IQCER
Certification
- CCM (Certified Case Manager)
- IQCER (Interqual Certified Expert Resource)
Accomplishments
VA Penguin Award Recipient for Exemplary Service
VA Research Journal Club
Six Sigma Yellow Belt Certification (2013)
UNC Subject Matter Expert: Cardiac Rehab, Pulmonary Rehab and Heart Failure Home Health Referrals
UNC Heart & Vascular Triad member
UNC Transitions of Care/Performance Improvement program member
Valley Health System SNF Return to Admit Prevention Committee
LEAN Implementation Course completed (2009)
ED Performance Improvement Team member
ED Practice Council member
References
References available upon request.
Timeline
Utilization Review Nurse
HCA Corporate (transitioned to Parallon)
01.2018 - Current
UM/CM Nurse
Southern Hills Hospital
12.2015 - 01.2018
Nurse Transfer Coordinator
VA Southern Nevada Health System
02.2015 - 12.2015
Utilization Review Nurse
Southern Hills Hospital
10.2014 - 02.2015
RN Case Manager
UNC Health Care
09.2012 - 10.2014
CM/UM Nurse
Spring Valley Hospital Medical Center
10.2010 - 06.2012
Bachelor of Science - Nursing
Western Carolina University
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