Michelle Davis
Burlington,WI
Summary
Talented Manager with expert team leadership, planning and organizational skills built during successful career. Smoothly equip employees to independently handle daily functions and meet customer needs. Diligent trainer and mentor with exceptional management abilities and results-driven approach.
Overview
24
24
years of professional experience
Work History
Manager Utilization Review/Bed Placement Center
Northwestern Medicine
01.2017 - Current
- Manage team of 26 employees, including 3 physicians, for the Northwest Region (Huntley, McHenry and Woodstock Hospitals) of Northwestern Medicine, including all personnel management duties
- Restructured regional physician advisor program complete with standardized Utilization Review metrics resulting in Northwestern Medicine systemwide scorecard
- Developed new evening ED observation RN which resulted in an additional $6.1 million financial pick up
- Created patient placement guidelines for each nursing operating unit within the Northwest Region hospitals
- Launched the role of the virtual ED Case Manager with intended focus on ED to observation conversion opportunities
- Facilitated the ED to Observation initiative which led to an additional $682,000 financial reimbursement for region in 5 month roll out period
- Developed and launched the Bed Placement Center, which is staffed by Utilization Review nurses who apply the criteria for appropriate patient class while also determining appropriate bed placement within the Northwest Region Hospitals
- Successfully integrated a team of nurses onto the Epic Electronic Medical Record system during the 2020 Covid Pandemic
- Transitioned Inpatient Utilization Review nurses to remote setting on a permanent basis during Covid pandemic
- Aligned with the other Northwestern Medicine Hospitals to create criteria for Intensive Care Step Down accommodation codes to appropriate charge capture nursing care for step down patients
- Lead team to meet organizational objectives of determining medical necessity of admissions and observation stays, appropriate utilization of healthcare resources, and collaboration with discharge planning
- Responsible for creating process to increase appropriate utilization of ambulatory patient status post-operatively that resulted in $504,052 of recouped funds on rebilled cases
- Act as a clinical resource to Utilization Review and Case Management team and ensure adherence to CMS regulations and guidelines
- Lead Utilization Review team through training, implementation and process changes in relation to MCG Utilization Review guidelines
- Responsible for creating and managing department capital and operating budget
- Collaborate with various departments both regionally and within the Northwestern Medicine system to improve procedures, increase productivity and both patient and employee satisfaction
- Educate multidisciplinary team and effective resource utilization, patient status, process breakdown and care enhancement
- Function as the eQHealth liaison, serving as a resource for questions and issues regarding the Illinois Medicaid patient population
- Responsible for granting and terminating accesses to eQHealth website
- Work in collaboration with the Supervisor of Utilization Review to develop agendas and facilitate Utilization Review team meetings
- Developed and implemented a process of collecting and reporting denials data within the Care Coordination department.
Registered Nurse/Emergency Utilization Specialist
Centegra Health System
01.2013 - 01.2016
- Served as Interim Manager of Utilization Review Department from November 2015-February 2016
- Provided direct leadership for twenty-one associates, managing the daily functions of the Utilization Review team including staffing, coaching, communication, policy enforcement, monitoring budget and expenditures, and collaboration with the multidisciplinary team
- Provided real time guidance to Emergency Department physicians regarding correct patient status (observation versus inpatient) when placing patients into the hospital
- Reviewed observation and inpatient cases using MCG criteria and clinical judgment to ensure correct patient type
- Established Care Coordination new associate orientation program including department specific computer programs, competencies, and overall education on the Utilization and ER Case Management roles
- Served as preceptor of new associates on the Care Coordination team, developing orientation schedules, coaching and mentoring new team members, and ensuring associates have the knowledge and training to effectively integrate into the system
- Created and managed the Emergency Utilization Specialist schedule for three hospital campuses, balancing individual requests while meeting needs of the organization
- Coordinated and presented extensive chart review and analysis of length of stay outliers for quarterly UR Committee
- Responsible for offering recommendations and executing plan of action determined by UR Committee physicians
- Led Utilization Process Improvement Committee
- Instituted multiple process improvement initiatives including standardized MCG review workflows, Insurance Super User Binders, At A Glance reference guides
- Represented Utilization Review team in system wide Rapid Improvement Events focusing on ER patient throughput and observation patient flow
- Responsible for continued data analysis and tracking of metrics to ensure commitment to established process
- Developed and instituted a Utilization Review chart audit tool for monthly self and peer chart reviews
- Worked with individual associates to provide feedback on performance and adherence to standardized review template
- Served as a resource to multiple departments including Health Information Management, Billing, Coding, Patient Access, Nursing, Social Services and Revenue Cycle
- Respond to queries about patient status, insurance payers, patient placement, medical records and other Utilization Review issues
- In preparation for opening of Huntley hospital, created detailed resource list of Huntley area Assisted, Supportive and Skilled Nursing facilities and provided education to Huntley Emergency Department team
- MCG Super User requiring collaboration with MCG regarding site testing and upgrade of product
- Involved in frequent communication with MCG and IT team to manage functionality of program issues
- Advocate on behalf of Centegra Health System to minimize denials and ensure appropriate payment from Illinois Medicaid.
Registered Nurse
Riverside Medical Center
01.2003 - 01.2013
- Led the nursing team in the role of charge nurse on a fast paced 25 bed Medical Pediatric unit
- Determined appropriate staffing for nurses, patient care technicians and unit secretaries based on acuity
- Responsible for determining the number of associates required to deliver safe and effective care
- Responsible for service recovery and managing patient and family questions and complaints
- Served as a preceptor for new associates and nursing students, orienting new team members to the adult medical and pediatric population
- As Unit Based Council Chairperson led initiatives involving standardization of bedside report and tracking pediatric blood culture contamination
- Participated in Nurse Clinical Ladder Program, and awarded Clinical Nurse Level II status for development and implementation of pediatric disease specific education
- Represented pediatric department in three-month comprehensive LEAN process improvement event focused on facilitating patient flow through the outpatient cancer treatment center
- Involved in a six-month Pre-Procedural Testing LEAN project concentrating on chart and patient readiness prior to procedure resulting in the creation of a pre-op clinic.
Registered Nurse
Northshore Healthcare
01.2001 - 01.2003
- Provided bedside nursing care for the acutely ill pediatric patient with diagnoses including asthma, bronchiolitis, RSV, rotavirus, and diabetes
- Worked collaboratively with physicians, patients and family members to create and implement care plans resulting in optimal patient outcomes and satisfaction
- Developed the ability to remain calm and professional throughout critical situations.
Patient Care Technician
Swedish American Hospital
01.2000 - 01.2001
- Assisted the nurse in caring for the postoperative patient in the PACU
- Communicated patient needs or change in condition to the nurse
- Provided patient privacy and maintained confidentiality at all times.
Education
Bachelor of Science in Nursing -
Saint Anthony College of Nursing
Rockford, IL01.2001
Pre-Nursing Curriculum -
Illinois State University
Normal, IL01.1999
Skills
- Financial Management
- Expense Tracking
- Operations Management
- Workforce Management
Publications
Farming: A Field of hazards., Nursing Spectrum, 13, 12, 6-7, 2000
References
Available upon request
Timeline
Manager Utilization Review/Bed Placement Center
Northwestern Medicine
01.2017 - Current
Registered Nurse/Emergency Utilization Specialist
Centegra Health System
01.2013 - 01.2016
Registered Nurse
Riverside Medical Center
01.2003 - 01.2013
Registered Nurse
Northshore Healthcare
01.2001 - 01.2003
Patient Care Technician
Swedish American Hospital
01.2000 - 01.2001
Bachelor of Science in Nursing -
Saint Anthony College of Nursing
Pre-Nursing Curriculum -
Illinois State University