Marlana Sutton
Hagerstown,MD
Summary
Compassionate and highly skilled Registered Nurse (RN, BSN) with over 18 years of diverse and hands-on experience in various healthcare settings. Adept at providing exceptional patient care, managing complex medical conditions, and working collaboratively with interdisciplinary teams to achieve optimal patient outcomes. Proficient in a range of clinical skills including patient assessment, medication administration, care management, and patient education. Committed to promoting patient safety, improving care quality, and advocating for patient needs. A proactive and adaptable leader with a strong commitment to continuous professional development and delivering evidence-based care.
Overview
19
19
years of professional experience
Work History
Multi Visit Navigator (RN)
Meritus Health
01.2024 - Current
- Conduct comprehensive assessments of patients' medical, social, and emotional needs to determine appropriate care plans and resources
- Provide information on how to manage their health conditions between visits, including self-care strategies, medication adherence, and lifestyle changes
- Assist patients in accessing necessary resources, such as transportation, social services, home health support, or financial assistance programs
- Ensure patients attend scheduled appointments by providing reminders and offering support to overcome any barriers to access (e.g., transportation issues, appointment confusion)
- Facilitate smooth transitions of care between hospital, outpatient, and home settings, ensuring patients understand their treatment plans and follow-up requirements
- Participate in multidisciplinary meetings to discuss patient progress, challenges, and upcoming treatment needs
- Advocate for the patient within the healthcare system, ensuring their voice is heard during care planning and decision-making processes
- Identify and address potential barriers to care, including financial challenges, access to healthcare services, language or cultural differences, or health literacy issues
- Analyzed patient outcomes data and presented findings in Excel-based reports, supporting evidence-based decision-making in patient care planning and treatment adjustments
- Played an integral role in reducing hospital admissions by proactively managing care for high-risk patients, ensuring appropriate follow-up care, and minimizing avoidable hospitalizations
Utilization Management Nurse
Meritus Health
01.2009 - 01.2024
- Review medical records, treatment plans, and clinical documentation to assess the medical necessity of healthcare services
- Evaluate clinical data to determine if services provided align with guidelines for appropriate care, based on established criteria (e.g., Milliman Care Guidelines, InterQual)
- Ensure that healthcare services are delivered in the most appropriate setting and level of care
- Process pre-authorization and concurrent reviews for medical procedures, treatments, medications, and hospital admissions
- Verify the medical necessity of requested services by reviewing clinical information and collaborating with physicians or healthcare providers
- Approve, deny, or recommend alternative treatment options based on clinical guidelines and patient needs
- Communicate with healthcare providers, physicians, and specialists to discuss treatment plans, service requests, and discharge plans
- Participate in multidisciplinary team meetings to discuss patient care plans, treatment options, and transitions of care
- Serve as a liaison between patients, healthcare providers, and insurance companies to ensure patients receive the care they need while being mindful of cost-effectiveness
- Assist in identifying opportunities to reduce unnecessary tests, hospitalizations, or readmissions by utilizing evidence-based guidelines and cost-control measures
- Review and manage appeals related to denials or disputed coverage decisions from patients, providers, or healthcare facilities
Infusion Center LPN
Meritus Health
01.2006 - 01.2013
- Conduct thorough assessments of patients before administering infusion therapies, including reviewing medical histories, allergies, and current medications
- Assess vital signs (blood pressure, pulse, temperature, respiratory rate) before and during infusions to ensure patient safety
- Administer intravenous (IV) medications, fluids, immunotherapy, antibiotics, blood products, and biologics to patients in accordance with physician orders and established protocols
Education
BSN -
Wilson College
Chambersburg, PA01.2024
LPN -
James Rumsey Technical Institute
Martinsburg, WV01.2004
Skills
Critical thinking, time management, patient assessment, teamwork, and problem-solving
Personal Information
Title: RN, BSN
Timeline
Multi Visit Navigator (RN)
Meritus Health
01.2024 - Current
Utilization Management Nurse
Meritus Health
01.2009 - 01.2024
Infusion Center LPN
Meritus Health
01.2006 - 01.2013
BSN -
Wilson College
LPN -
James Rumsey Technical Institute
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