Martha Lonnquist
Nottingham,MD
Summary
Experienced Pediatric NICU RN with close to 20 years working in Utilization Management, Discharge Planning. Daily Medical Record Reviews and works as a team member to Facilitate discharge planning Considerable knowledge of InterQual and Milliman Criteria for Inpatient admissions as well as continued stay. Works well and collaboratively with Social work Discharge planners Case Management Medical Director. Meet with Families to discuss HH DME needs make referrals to Community Agancies Case Management
Overview
36
36
years of professional experience
Work History
Utilization Review Specialist
JOHNS HOPKINS HOSPITAL
- Daily Chart reviews for all inpatient admissions to NICU as well as Hi risk OB patients, preterm labor, ROM, Ruptured Membranes Etc.
- Refer NICU babies to Lower Level of Care when appropriate- Mt. Washington
- Monitor progress and Levels of Care
Utilization Review Nurse
Ascension St Agnes Hospital
Baltimore, MD
02.2025 - Current
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Improved patient care quality by conducting thorough utilization reviews and making recommendations for optimal treatment plans.
01.2020 - Current
- COVID
- Severe Reaction to Second Vaccine after Initial Covid infection
- Lengthy and Serious lengthy inpatient hospitalization and inpatient stay 2020-2021 10 Months
- ICU DIALYSIS, Life Support
- December 2021 Kenan Rehab for Reconditioning and Strengthening
- Home upon discharge and today Fully recovered ready to return to wor.
- Preferable Part time
Utilization REVIEW RN
CENTENE
01.2018 - 01.2020
- Daily Chart reviews for all detained infants, NICU babies
- Meetings with Social work, Medical Advisor to form Discharge plan’
- Appropriate referrals to HH Community Services Case Management upon discharge
Utilization Review RN
RIVERSIDE HEALTH-UMMS
01.2014 - 01.2018
- Review Manage follow closely all Detained babies, NICU and Hi Risk OB Patients
- Daily use of InterQual and Milliman Criteria
- Referrals as needed to HH DME Community Agencies Case MEneegment
Utilization REVIEW RN
UNITED HEALTHCARE
01.2004 - 01.2008
- Review and approve per Guideline’s inpatient admits and continued stay for all preterm NICU infants detained babies, Hi risk OB members throughout the state of Maryland Participate in weekly discharge rounds, Referrals to REM, Report VLBW infants to the State, Referrals to Case Management, Special needs
Clinical RN Pediatric Critical CARE NICU
JOHNS HOPKINS HOSPITAL
01.1990 - 01.2004
- Direct patient care to the Critically ill Pediatric child and NICU babies
Education
BA - Nursing
College of Notre Dame
Baltimore, Md01.1997
AA Degree - Nursing
Harford Community College
01.1985
Skills
- Daily use of Word, Excel, InterQual Milliman EPIC Meditech
- Actively participate in weekly patient Care rounds
- Very knowledgeable in Medicaid Medicare and Commercial Payers
- Act as a patient Advocate and implement Total patient care thru TEAM Nursing process
- Active referrals upon discharge to Case Management, Special Needs, Case Management
- Maintain thorough and Confidential documentation in Electronic Medical Records
- Alert meet with Medical Advisor of any pertinent clinical changes Diagnostic results
Timeline
Utilization Review Nurse
Ascension St Agnes Hospital
02.2025 - Current
01.2020 - Current
Utilization REVIEW RN
CENTENE
01.2018 - 01.2020
Utilization Review RN
RIVERSIDE HEALTH-UMMS
01.2014 - 01.2018
Utilization REVIEW RN
UNITED HEALTHCARE
01.2004 - 01.2008
Clinical RN Pediatric Critical CARE NICU
JOHNS HOPKINS HOSPITAL
01.1990 - 01.2004
Utilization Review Specialist
JOHNS HOPKINS HOSPITAL
BA - Nursing
College of Notre Dame
AA Degree - Nursing
Harford Community College