Mary Kaitlyn Hightower (Markiewith)
Overview
12
12
years of professional experience
1
1
Certification
Work History
Corporate Utilization Review Lead RN Educator
Quorum Health Care
03.2025 - Current
- Educate and train new registered nurses remotely in the centralized utilization review process for inpatient hospital stays by training on how to conduct inpatient assessments for acute admissions from the emergency department, direct inpatient admissions, elective surgeries, retrospective evaluations for discharged patients, post-partum assessments, newborn evaluations, and continued stay reviews. Instruct on effective communication and escalation of cases to attending physicians concerning the patient's level of care at the facilities where they are being treated. Educate on how to handle pre-determination denials and engage with physician advisors. Train on interactions with insurance companies regarding the patient's level of care, obtaining authorizations for inpatient hospital stays, and setting up peer-to-peers between medical directors and collaborating physicians. Provide training on inpatient criteria using InterQual and applying this information to inpatient reviews. Creating job aids and recourses with Microsoft applications. Oversee ongoing education, remediation, and conducting audits for existing team members.
- Conduct bi-weekly video team meetings with management to provide updates, reminders, and educational content to current team of registered nurses.
- Support managerial responsibilities such as organizing staffing, overseeing team performance metrics, delegating tasks, and creating daily assignments for team members.
- Conduct thorough inpatient evaluations for patients enrolled in Florida Medicaid.
Corporate Utilization Review Lead RN Educator
Steward Health Care
12.2022 - 03.2025
- Precept new utilization review RN team members through the process of inpatient centralized utilization review by training how to complete inpatient reviews for acute admissions through emergency department, elective surgery reviews, retrospective reviews for patients who have discharged, post-partum reviews, newborn reviews and continued stay reviews. Train how to communicate and escalate cases to the attending physicians regarding patient’s level of care at the facilities where patients are receiving care. Train how to complete pre-determination denials and communicating with physician advisors. Train how to communicate with insurance companies regarding patient’s level of care and authorizations for inpatient hospital stays. Training team members on inpatient criteria through InterQual. Responsible for continuing education and remediation for current team members. Presenting bi-weekly team meetings with management giving updates, reminders and education. Assisting with managerial duties such as timecard management, organizing staffing, delegating tasks, creating daily assignments for team members.
- Case Management Inpatient Utilization Review RN December 2022: RN for Davis Hospital and Salt Lake Regional: Recognizing hospital levels of care. Identifying if patients meet in patient criteria by using the evidence-based clinical decision support tool InterQual. Utilize a complete and systematic methodology/process to assess, plan, implement, evaluate and provide patient care coordination from pre-hospital through post-hospital care. Communicate with Physician advisors and in-house physicians regarding patient’s level of care. Assist in the development of physician profiles to identify over/under utilization patterns. Support Steward Health Care's and hospital goals and objectives. Work within regulatory compliance guidelines. Collaborate with all healthcare disciplines such as the inhouse care management team, in house registration, PAC team, authorization coordinators, physicians, management, to assure appropriate and timely services. Assess the medical appropriateness, quality, and cost-effectiveness of proposed hospital, medical, and surgical services. Collaborate with the multidisciplinary team to assist patient with benefits management. Communicate with payers to obtain authorization. Identify and plan strategies to optimize inpatient length of stay and resource utilization.
Lead Nurse/Relief Charge Nurse
West County Detention Facility
05.2018 - 09.2022
- Address medical and mental health problems that arise in facility while also managing administrative tasks such as scheduling, staffing, and monitoring patient care. Supervising and delegating assignments to a team of 5 registered nurses, 4 licensed vocational nurses, 3 medical assistants, 1 phlebotomist, 1 dental hygienist, 4 mental health clinicians/social workers. Consulting with medical doctor, psychiatrist, dentist, pharmacist and pharmacy technicians to ensure quality of patient care. Auditing patient’s charts for complete documentation to ensure safe care (utilizing Epic EMR system)
- Learning and teaching new policies and systems quickly and proficiently within a short amount of time.
- Case Management RN: Ensure patients are safely discharged back into the community upon release by providing patient education regarding medication regimen, follow up care visits, and ensuring patients achieve health literacy regarding their chronic conditions during their stay at facility. Identifying patients who are in need of further resources while in facility and also after being discharged upon release into the community. Requesting appropriate consultations for these further resources. Work hand in hand with Mental Health clinician social workers, psychiatric doctors and medical doctors to place patients in alternative levels of care such as skilled nursing facilities, rehabilitation facility, substance abuse programs, psychiatric hospitals and shelters. Identifying if patients are in acute distress upon intake and determining if they need to be transported to hospital for direct admit or to the emergency department. Managing facility resources to help reduce health care costs.
- Chronic Care RN: Identifying patients upon intake with chronic health conditions such as hypertension, diabetes mellitus, asthma, chronic kidney disease, heart failure, high cholesterol, coronary heart disease, congestive heart failure, patients who are immunocompromised and patients who are pregnant. Scheduling health maintenance lab work for these patients, scheduling follow-up care doctor’s appointments for these patients, ensuring these patients are seen within 7-28 days upon intake by medical doctor, ensuring appropriate medications are ordered at intake, scheduling routine vital signs and peak flow tests.
- Psychiatric RN: Identifying patients with mood disorders, patients who appear to be experiencing psychiatric crisis, or who are experiencing psychiatric distress (for example, patients who appear to be disorganized or experiencing side effects of psychiatric medications). Consulting psychiatrists regarding psychiatric medications. Being able to identify patients who are in need of further evaluation and closer monitoring. Monitoring patients in restraints. Administering PO and IM antipsychotic medications. Preforming mental health assessments. Identifying patients who are at risk for harming themselves or harming others.
- Telephone Triage/Advice RN: Providing medical, dental and mental health information over the phone to patients. Making health assessments for patients over the telephone (medical, dental, mental health). Identifying patients who need routine, urgent or emergent follow up visits by RN or doctor. Seeing patients after phone call for further evaluation at nursing sick call appointment then making medical doctor, dentist, gynecologist or psychiatrist referral if needed.
- Substance Abuse Detox RN: Identifying and monitoring patients who are detoxing from alcohol, benzodiazepines, opiates, methamphetamines and initiating appropriate withdrawal protocol including scheduled monitoring and medication administration. Starting patients on Medication Assistance Treatment (MAT) program. Scheduling follow visits with medical doctor and substance abuse counselors. Assisting patients with entry into substance abuse program upon facility release.
- Utilization of the Epic EMR system. Well versed in Microsoft Word, Excel, and PowerPoint.
- Preceptor: Orienting new grads and new hires to the unit while following facility policy and best practice procedures.
Full-time Registered Nurse Supervisor
BrightStar Health Care Lafayette CA
09.2017 - 01.2020
- Supervising a team of LVNs, CNAs, and caregivers providing care in the home setting or skilled nursing facility setting. Auditing patients charts and care provider documentation. Identifying and teaching care providers if patients are in acute distress at home and how to determine if they need to be transported to hospital emergency department.
- Case management: Completing case set up - meeting with family and patient who is expecting to or has already been discharged from SNF, rehab, or hospital back to home and coordinating patient’s continuation of care in their home. Setting up patient specific plan of care for care providers to follow. Ensuring patients have appropriate assistive devices to use in their homes and when leaving their home. Ensuring safe patient care is being provided within home. Coordinating and scheduling medical appointments, physical therapy, and occupational therapy appointments either outpatient or within the patient’s home. Organizing patient’s medications “med sets” so patients can easily access daily medications at home.
Full-time Registered Nurse
Holmes Regional Medical Center
01.2017 - 10.2017
- Full-time Registered Nurse on Orthopedic and Medical Surgical Unit 6/2017- 10/16/17: Admitting new patients. Monitoring vital signs and blood sugars. Administering medications (IV, PO, IM, topicals). Operating and maintaining equipment (e.g., IV tubes, feeding tubes, oxygen tubes, catheters). Performing and/or ordering tests and assessments. Documenting patient needs and progress. Consulting medical doctor.
- Part-time Nurse Tech on Orthopedic and Medical Surgical Unit 1/2017-5/2017: Assess vital signs and report to RN. Insert and discontinue foley catheters. Discontinue intravenous lines. Assist patient's with showering, bed bathing, ambulating, changing linens, feeding, assistance to toilet or bed side commode.
Full-time home health CNA
BrightStar Health Care
01.2014 - 01.2016
- Full-time home health CNA, also assisted with Physical therapy patients
- Started in Lafayette CA in January of 2014 and moved to Melbourne, FL, in August of 2014
Full-time CNA
Island Health and Rehabilitation Center
08.2015 - 12.2015
- Full-time CNA
Caregiver
Private Home Care as a CNA
08.2014 - 05.2015
- Caregiver for 87-year-old women with dementia
Full-time CNA
Genesis Home Health
08.2014 - 01.2015
- Full-time CNA
Full-time CNA
ManorCare Health Facility
01.2014 - 08.2014
- Full-time CNA
Education
Master of Business Administration - Healthcare Administration
Western Governors University
03.2026
Master of Science - Nursing - Leadership and Management
Western Governors University
07.2023
Bachelor of Science - Nursing - Leadership and Management
Western Governors University
09.2019
Associate of Science - Nursing
Keiser University
06.2017
Associate of Arts - Liberal Arts, Math and Science
Los Medanos College and Diablo Valley College
01.2012
Associate of Arts - Arts and Humanities
Los Medanos College and Diablo Valley College
01.2012
Skills
- Microsoft Excel-Proficient in analyzing and visualizing data with Excel Skilled in creating complex formulas, pivot tables, and charts to interpret data trends
- Microsoft Word -Proficient in creating and formatting documents using Word
- Microsoft PowerPoint - Skilled in designing engaging presentations using PowerPoint
- Microsoft Outlook - Proficient in overseeing email communications and calendars through Outlook
- Microsoft OneNote - Competent in notetaking and organization utilizing OneNote
- Microsoft Teams - Skilled in using Teams for collaboration and communication Skilled in hosting video meetings and sharing files effortlessly
- Microsoft SharePoint - Experienced in utilizing SharePoint for document management and collaboration
Certification
- Registered Nurse (Florida Board of Nursing)
- License # 9461482
- Registered Nurse (California Board of Nursing)
- License # 95143911
- Registered Nurse (Connecticut Board of Nursing)
- License # 199816
- Registered Nurse (Utah Department of Commerce)
- License # 13205927-3102
Professional Organization and Achievements
- Member of HERT (Hospital Emergency Response Team) during category 5 hurricane Irma at Holmes Regional Hospital in Melbourne FL, "during" storm 72 hour shift 9/9/17-9/11/17
- Member, NSNA, 2016
- Attendee, NSNA Annual Convention, Orlando March 11, 2016
- Leadership Distinction program, Keiser University, 2017
- Alpha Delta Nu Keiser University Nursing Honors Society, 2017
- Active participant in Melbourne International Airport’s Mass Casualty event, 2016
- Organized and facilitated all aspects of a speaker event by Mike Linares that was held at Keiser University and attended by students, staff, and faculty, 2017
Timeline
Corporate Utilization Review Lead RN Educator
Quorum Health Care
03.2025 - Current
Corporate Utilization Review Lead RN Educator
Steward Health Care
12.2022 - 03.2025
Lead Nurse/Relief Charge Nurse
West County Detention Facility
05.2018 - 09.2022
Full-time Registered Nurse Supervisor
BrightStar Health Care Lafayette CA
09.2017 - 01.2020
Full-time Registered Nurse
Holmes Regional Medical Center
01.2017 - 10.2017
Full-time CNA
Island Health and Rehabilitation Center
08.2015 - 12.2015
Caregiver
Private Home Care as a CNA
08.2014 - 05.2015
Full-time CNA
Genesis Home Health
08.2014 - 01.2015
Full-time home health CNA
BrightStar Health Care
01.2014 - 01.2016
Full-time CNA
ManorCare Health Facility
01.2014 - 08.2014
Master of Science - Nursing - Leadership and Management
Western Governors University
Bachelor of Science - Nursing - Leadership and Management
Western Governors University
Associate of Science - Nursing
Keiser University
Associate of Arts - Liberal Arts, Math and Science
Los Medanos College and Diablo Valley College
Associate of Arts - Arts and Humanities
Los Medanos College and Diablo Valley College
Master of Business Administration - Healthcare Administration
Western Governors University
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