Melissa Dupree
Casselberry,FL
Summary
Dedicated Utilization Management Nurse with 2 years of experience optimizing healthcare resource utilization, ensuring cost-effective and high-quality patient care. Proficient in conducting utilization reviews, collaborating with healthcare teams, and implementing strategies to enhance overall efficiency and compliance with regulatory standards.
Overview
13
13
years of professional experience
1
1
Certification
Work History
RN Reviewer (utilization management)
Cohere Health
09.2021 - Current
- Conduct comprehensive reviews of patient medical records to evaluate the appropriateness and necessity of healthcare services, ensuring compliance with established guidelines
- Facilitate communication among healthcare professionals to ensure coordinated and efficient patient care, minimizing unnecessary services and reducing healthcare costs
- Stay abreast of healthcare policies, regulations, and insurance guidelines to ensure adherence and compliance in utilization management processes
- Participate in quality improvement initiatives, providing insights and recommendations to enhance utilization management processes and patient outcomes.
Clinical Manager, RN
Pinnacle Home Care - Orlando, FL
04.2020 - 09.2021
- Receive case referrals
- Review available patient information related to case, including disciplines required, to determine home care needs
- Assign appropriate clinicians to case
- Review and evaluate each case by reviewing the services provided by clinicians, conferences, record review, discuss and verify impressions, instruct, and guide clinicians to promote more effective performance and delivery of quality home care services, and is always available during operating hours to assist clinicians as appropriate
- Assist clinicians in establishing immediate and long-term therapeutic goals, in setting priorities, and in developing plan of care coordinate case conference meetings with organization personnel to facilitate coordination of care Assess clinicians on an ongoing basis to ascertain their understanding and compliance with policies and procedures.Promote appropriate utilization of services based upon patient's acuity and medical necessity
Nurse Case Manager
Kassy Home Health - Altamonte Springs, FL
09.2019 - 04.2020
Assistant Director of Nursing
Nirvana Health Services - Altamonte Springs, FL
07.2019 - 09.2019
- Leverage healthcare leadership and clinical expertise to manage the daily patient care activities for patients with a broad range of conditions in their residential environments
- Delegate staffing assignments while determining appropriate placements on the basis of patient needs and available skill sets
- Ensure that all employees are aware of and compliant with organizational policies and procedures in addition to federally regulated healthcare guidelines
- Identify and resolve department deficiencies through implementation of strategic and corrective action plans; monitor processes and procedures to promote continuous employee and organizational improvements
- Deliver education and training to new and continuing employees to facilitate understanding of best care practices to assist individuals in sustaining optimal health and quality of life
- Facilitate HR processes including recruitment and hiring of highly talented healthcare professionals
- Cultivate and maintain an astute focus on quality care delivery by promptly and professionally resolving patient care concerns or complaints
- Reverse staff morale in a struggling organization by providing critical leadership and collaborative care approaches to ensure exceptional and collegial patient care provision.
Nurse Case Manager
Nirvana Health Services - Altamonte Springs, FL
01.2011 - 01.2019
- Independently managed a caseload of 150 to 200 patients with a broad range of health conditions
- Initiated and developed the patient's plan of care including requisite treatment and established care objectives
- Liaised between patients, family members, and physicians to advocate for services to meet all identified healthcare needs in a timely and high-quality manner
- Collaborated with multidisciplinary health professionals to coordinate and monitor care plan implementation ensuring that all care was delivered safely, effectively, and efficiently
- Managed patient cases by eliminating gaps in care and duplication of services to sustain cost effective treatment and optimized healthcare outcomes.
Education
Associate of Applied Science in Nursing - Nursing
Excelsior College
Albany, NY01.2019
Diploma in Licensed Practical Nursing - Licensed Practical Nursing
Orland Technical College
Orlando, FL01.2011
Skills
- Strong analytical and critical thinking skills for effective utilization reviews
- Excellent communication and interpersonal skills to collaborate with healthcare teams
- In-depth knowledge of healthcare regulations, policies, and reimbursement processes
- Proficiency in utilizing electronic health record (EHR) systems and utilization management software
- Ability to make sound decisions based on clinical judgment and evidence-based practices
- Detail-oriented with a focus on accuracy in documentation and reporting
- Patient Education
- Time Management
- Cultural Competence
- Attention to Detail
- Critical Thinking
- Case Management
Certification
- RN
- BLS Certification
Assessments
- Clinical judgment, Highly Proficient, 09/2019
- Work style: Reliability, Highly Proficient, 09/2019
Timeline
RN Reviewer (utilization management)
Cohere Health
09.2021 - Current
Clinical Manager, RN
Pinnacle Home Care - Orlando, FL
04.2020 - 09.2021
Nurse Case Manager
Kassy Home Health - Altamonte Springs, FL
09.2019 - 04.2020
Assistant Director of Nursing
Nirvana Health Services - Altamonte Springs, FL
07.2019 - 09.2019
Nurse Case Manager
Nirvana Health Services - Altamonte Springs, FL
01.2011 - 01.2019
Associate of Applied Science in Nursing - Nursing
Excelsior College
Diploma in Licensed Practical Nursing - Licensed Practical Nursing
Orland Technical College
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