Melissa Hopper
Decatur,Alabama
Summary
Worked as a utilization review/ case manager with 7+ years of experience in pre certification, concurrent review, discharge review and retro reviews with all payers. Case management experience is in discharge planning by procuring equipment, referring patient's to home health agencies, and collaborating with facilities for geriatric placements. Fields worked have been in the ER, Medical units, Medical - Surgical Unit, Peripheral Vascular Unit, Intensive Care Unit, Labor and Delivery, Nursery and Behavioral Health Units.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Behavioral Health Utilization Reviewer
Decatur Morgan Hospital - West Campus
12.2021 - Current
- Behavioral health utilization review of child, adolescent, adult, and geriatric units full time.
- Responsibilities include performing concurrent reviews with Medicaid, Medicare, Blue Cross Blue Shield of Alabama, and other commercial payers to ensure medical necessity of admission and extended inpatient stay.
- Other duties include but are not limited to assisting in pre-certification of admissions, discharge reviews, and geriatric placements as needed.
ER Case Manager/Utilization Reviewer
Decatur Morgan Hospital
12.2018 - 12.2021
- ER Case Manager/ Utilization Reviewer full time. Responsibilities included pre-certification of inpatient and observation admissions though ER
- Initial case management assessment for discharge planning
- Procuring equipment for patients discharging from ER
- Float Utilization Reviewer/ Case Manager to 3 separate Medical Units on 2 different campuses, as well as Medical/Surgical, Peripheral Vascular Unit, ICU units, labor and delivery and nursery as needed.
Weekend Charge Nurse
Decatur Morgan Hospital
09.2017 - 12.2018
- Weekend charge nurse on 4 North medical surgical unit, full time.
- Duties included making patient bed assignments, and staff/ patient assignments
- Ensuring all documentation appropriately reflected in medical record by all staff
- All core measures met and documented appropriately
- Troubleshooting issues as they arose on unit
- Discharging all patients on weekend
- Admission and discharging infusion patients as needed
Utilization Reviewer/Case Manager
Decatur Morgan Hospital
09.2014 - 09.2017
- Utilization Reviewer/ Case Manager on 4 South Orthopedic/ Urology Unit and 4 North Medical- Surgical unit, full time.
- Responsibilities included pre-certification, concurrent review, discharge review, and retro reviews on all patients to ensure medical necessity of admission and extended stay.
- Initial case management assessment and follow up in discharge planning of all patients.
- Collaboration with medical doctors and social workers for medical necessity and extended stay in discharge planning.
Charge Nurse
Decatur Morgan Hospital
03.2013 - 08.2014
- Charge nurse on 4 South/Orthopedic/ Urology Medical Surgical Unit, full time
- Responsibilities included patient bed assignment and faculty patient assignment
- Admission and discharge documentation on each patient
- Ensuring documentation by staff was accurate and reflected in the medical record and education as needed
- Ensuring core measures were met and documented in the medical record and education as needed
- Troubleshooting issues on the unit as needed
Registered Nurse
Decatur Morgan Hospital
08.2010 - 03.2013
- Registered Nurse on 4 North/orthopedic, medical-surgical unit, full time
- Responsibilities included initial assessment, documentation of patient reflected accurately in the medical record
- Administering medications and documenting medications in a timely manner
- Troubleshoot patient issues as needed
- Admission and discharge documentation accurately on each patient
- Managing orthopedic and urology patients pre and post surgery
Registered Nurse
Huntsville Hospital Main
11.2010 - 12.2012
- Registered Nurse on Joint Camp orthopedic unit, prn
- Duties included assessment of post op orthopedic patients
- Ensuring documentation was accurately reflected in the medical record
- Managing pain control for patient via pain pump
- Distributing medications and documenting medications in a timely manner
- Troubleshooting patient issues as needed
Nurse Tech
Decatur Morgan Hospital
04.2009 - 08.2010
- Patient Care Aide on 4 North/orthopedic, medical-surgical unit, part-time
- Responsibilities include assisting patient's with all ADLS
- Accurate vital signs and finger stick blood sugars taken and reported to nurse if not within normal limits
- Simple bandage changes and removal of IVs at discharge
- Transportation of patients to procedures and at discharge
- Preparing pre op patients for surgery
Homemaker
05.2006 - 04.2009
Education
Associate of Science - Registered Nurse
Calhoun Community College
Tanner, Alabama07.2010
High School Diploma -
Athens High School
Athens, Alabama05.1996
Skills
- Knowledge in coordination and promoting continuity of care and cost effectiveness through functions of case management, utilization review, and authorization management
- Knowledge and use of discharge planning, case management referral criteria, utilization review and levels of care
- Computer literate and willingness to learn new applications
- Experience in task prioritization, highly organized, and attuned to time sensitive cases
Certification
- Registered Nurse, 1-128286, AL, 09/11/2010, 04/17/2023
- MSL, AL, 04/17/2023, 12/31/2025
References
On Request
Timeline
Behavioral Health Utilization Reviewer
Decatur Morgan Hospital - West Campus
12.2021 - Current
ER Case Manager/Utilization Reviewer
Decatur Morgan Hospital
12.2018 - 12.2021
Weekend Charge Nurse
Decatur Morgan Hospital
09.2017 - 12.2018
Utilization Reviewer/Case Manager
Decatur Morgan Hospital
09.2014 - 09.2017
Charge Nurse
Decatur Morgan Hospital
03.2013 - 08.2014
Registered Nurse
Huntsville Hospital Main
11.2010 - 12.2012
Registered Nurse
Decatur Morgan Hospital
08.2010 - 03.2013
Nurse Tech
Decatur Morgan Hospital
04.2009 - 08.2010
Homemaker
05.2006 - 04.2009
Associate of Science - Registered Nurse
Calhoun Community College
High School Diploma -
Athens High School
- Registered Nurse, 1-128286, AL, 09/11/2010, 04/17/2023
- MSL, AL, 04/17/2023, 12/31/2025
Similar Profiles
Brianna CardoBrianna Cardo
Psychiatric Registered Nurse at Decatur Morgan Hospital - West CampusPsychiatric Registered Nurse at Decatur Morgan Hospital - West Campus
Mary-Kathryn HuntMary-Kathryn Hunt
Clinical Counseling Intern at Decatur Morgan Hospital West CampusClinical Counseling Intern at Decatur Morgan Hospital West Campus
William BennettWilliam Bennett
CT/Radiologic Technologist at Decatur Morgan Hospital - Parkway CampusCT/Radiologic Technologist at Decatur Morgan Hospital - Parkway Campus