Michelle Reed
New Bern,United States
Summary
Results-oriented Utilization Management leader with expertise in project management and regulatory compliance. Led high-performing teams and developed training programs that enhanced documentation integrity and reimbursement strategies. Improved patient flow through streamlined workflows and performance monitoring. Strong background in strategic planning, change management, and IT infrastructure development, driving organizational improvements and navigating complex challenges.
Overview
14
14
years of professional experience
Work History
System Director of Utilization Mngmnt/Project Leader
St. Luke's Health System
Boise, ID
02.2020 - 11.2025
- Developed and directed Utilization Management program with three supervisors, one manager, and fifty-eight nurses.
- Developed and led Project Improvement compliant processes for pre-authorization, concurrent review, and discharge planning.
- Developed and led Project Improvement processes for comprehensive thirteen-week onboarding curriculum for new nurses, including career progression pathways.
- Improved clinical documentation integrity to ensure accurate diagnoses and optimize reimbursement.
- Collaborated with revenue cycle leaders, physician advisors, and executives to align clinical and financial outcomes.
- Cultivated relationships with payers, including Blue Cross, Medicaid, Medicare Advantage, and commercial programs.
- Monitored performance metrics to enhance program effectiveness and improve patient outcomes.
- Enhanced team engagement by conducting structured one-on-one meetings and performance evaluations.
Healthcare Consultant | Interim Director
Covenant Healthcare
Saginaw
12.2017 - 11.2019
- Provided consultative leadership for case and care management performance improvement initiatives, improving operational efficiency and consistency.
- Supported Milliman/InterQual enhancements in Utilization Review revenue processes, leading to improved financial outcomes.
- Reviewed and revised care/case management programs (high-risk stratification, readmission assessments, complex discharge planning) to align with CMS Conditions of Participation (CoPs).
- Led Epic (EHR) implementation efforts by training key stakeholders and partnering with IT builders to support effective adoption.
- Developed educational materials that enhanced staff clinical decision-making and bolstered utilization management process improvement capabilities.
- Managed end-to-end project lifecycles from concept development and budgeting through team leadership and implementation.
- Applied best practices to support growth and process optimization within a Federally Qualified Health Center (FQHC).
Healthcare Consultant | Interim Director
Byrd Health Care Consulting & Reed Health Care Consulting
10.2014 - 11.2019
- Provided consultative leadership for case and care management performance improvement initiatives, improving operational efficiency and consistency.
- Led Epic (EHR) implementation efforts by training key stakeholders and partnering with IT builders to support effective adoption.
- Supported enhancements of Milliman/InterQual within Utilization Review processes, contributing to improved financial outcomes.
- Reviewed and revised care/case management programs to align with CMS Conditions of Participation (CoPs), ensuring compliance and quality standards.
- Developed educational materials that enhanced staff clinical decision-making and improved utilization management processes.
- Managed end-to-end project lifecycles from concept development and budgeting through team leadership and implementation.
- Applied best practices to support growth and process optimization within a Federally Qualified Health Center (FQHC).
Healthcare Consultant | Interim Director
LMC
New Orleans
11.2016 - 12.2017
- Provided consultative leadership for case and care management performance improvement initiatives, improving operational efficiency and consistency.
- Led Epic (EHR) implementation efforts by training key stakeholders and partnering with IT builders to support effective adoption.
- Reviewed and revised care/case management programs to align high-risk stratification, readmission assessments, and complex discharge planning with CMS Conditions of Participation (CoPs).
- Supported Milliman/InterQual enhancements within Utilization Review revenue processes to improve financial outcomes.
- Developed educational materials that enhanced staff clinical decision-making and utilization management capabilities.
- Managed end-to-end project lifecycles, overseeing concept development, budgeting, team leadership, and implementation.
- Applied best practices to support growth and process optimization within a Federally Qualified Health Center (FQHC).
Healthcare Consultant | Interim Director
Denver Health Hospital Authority
Denver
10.2014 - 09.2016
- Provided consultative leadership for case and care management performance improvement initiatives, improving operational efficiency and consistency.
- Reviewed and revised care/case management programs (high-risk stratification, readmission assessments, complex discharge planning) for alignment with CMS Conditions of Participation (CoPs).
- Led Epic (EHR) implementation efforts by training key stakeholders and partnering with IT builders to support effective adoption.
- Supported Milliman/InterQual enhancements in Utilization Review revenue processes, contributing to improved financial outcomes.
- Managed end-to-end project lifecycles from concept development and budgeting through team leadership and implementation.
- Developed educational materials that enhanced staff clinical decision-making and utilization management process improvement capabilities.
- Applied best practices to support growth and process optimization within a Federally Qualified Health Center (FQHC).
Executive Director - Case Management & Transitions of Care
John Peter Smith Health Network
Fort Worth
10.2013 - 10.2015
- Led strategic initiatives improving patient care quality and access across health network.
- Revamped case management and utilization review programs to enhance health outcomes and throughput.
- Boosted patient flow by 35% through identifying constraints and leading improvement initiatives.
- Implemented evidence-based guidelines for standardized care planning and utilization review practices.
- Developed staff training programs aligning with organizational mission and values, enhancing care transitions.
- Collaborated with stakeholders to develop organizational policies and procedures.
- Oversaw budget management and resource allocation for multiple departments.
- Partnered with medical management director to conduct audits ensuring compliance and effectiveness.
- Established cross-agency partnerships supporting treatment planning and data analysis.
- Cultivated relationships with key stakeholders, fostering collaboration and support for organizational goals.
- Contributed to management committees through case presentations and structured problem-solving.
- Recruited, trained, mentored, evaluated, coached, and managed staff members to ensure success in achieving their goals.
- Directed community outreach programs to improve public health awareness.
(Consultant) - Case Management Services
Vidant Health: Vidant Medical Center
Greenville
10.2011 - 10.2013
- Led a department operations redesign for a 989-bed acute care, Level 1 trauma, teaching hospital with 32+ direct reports, strengthening transitions of care and patient flow.
- Partnered with CareWebQI (MCG) to streamline care coordination and develop scorecards that standardized performance metrics.
- Supported the Epic 2015 Care Management build, integrating MCG INDICA (formerly CareWebQI).
- Optimized Release of Information (ROI) and NC Tracks workflows to improve health information coordination.
- Reduced length of stay and cost per case in targeted service lines by implementing a best-practice progression-of-care model.
- Implemented rapid rounding across 12 units to address readmissions and manage top 10 DRGs.
- Chaired SNF & Home Health/Hospice Quarterly Committee, facilitating sessions that engaged 50+ participants.
- Managed donor relations and maintained a database of 1,000+ contributors.
Education
Master of Social Work - Tempe
Arizona State University
Tempe05-2009
Bachelor of Science - Social Work
Olympia University
Olympia05-1996
Skills
- Utilization management
- MCG guidelines
- Clinical documentation
- Payer management
- Audit compliance
- Healthcare analytics
- EHR implementation
- Project management
- Care coordination
- Resource optimization
- Staff resource allocation
- Performance assessment
- Strategic planning
- IT management
- Integration services
- Data analysis
- Change management
- Problem solving
- Team leadership
- Team collaboration
- Analytical thinking
- Root-cause analysis
- Communication skills
- Verbal communication
- Written communication
- Staff training
- Org development
Personal Information
References available upon request
Timeline
System Director of Utilization Mngmnt/Project Leader
St. Luke's Health System
02.2020 - 11.2025
Healthcare Consultant | Interim Director
Covenant Healthcare
12.2017 - 11.2019
Healthcare Consultant | Interim Director
LMC
11.2016 - 12.2017
Healthcare Consultant | Interim Director
Byrd Health Care Consulting & Reed Health Care Consulting
10.2014 - 11.2019
Healthcare Consultant | Interim Director
Denver Health Hospital Authority
10.2014 - 09.2016
Executive Director - Case Management & Transitions of Care
John Peter Smith Health Network
10.2013 - 10.2015
(Consultant) - Case Management Services
Vidant Health: Vidant Medical Center
10.2011 - 10.2013
Master of Social Work - Tempe
Arizona State University
Bachelor of Science - Social Work
Olympia University