Nicole Ertl
Dayton,MN
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Utilization Management Supervisor
Hennepin Health
Minneapolis, MN
06.2023 - 12.2023
- Conducted audits of case files to ensure accuracy and completeness of documentation according to standards set forth by the organization.
- Issued work schedules, duty assignments and deadlines for office or administrative staff.
- Participated in subordinates' tasks to facilitate productivity or help overcome difficulties.
- Guided employees in handling difficult or complex problems.
- Oversaw daily workflow of utilization review cases and monitored completion of timely reviews.
- Reviewed employees' work to check adherence to quality standards and proper procedures.
- Monitored performance metrics related to utilization management outcomes such as length of stay and episode duration, readmission rates.
Utilization Management Specialist RN
M Health Fairview
Minneapolis, MN
11.2020 - 02.2023
- Performed concurrent reviews of inpatient admissions, ensuring appropriate level of care was provided.
- Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
- Contacted insurance carriers to obtain authorizations for services delivered to patients.
- Reviewed appeals from members or providers regarding denied services or treatments.
Utilization Management RN
North Memorial Health
Robbinsdale, MN
11.2019 - 03.2020
- Determined medical necessity and cost-effectiveness of services through utilization review processes.
- Reviewed denial letters issued by insurance companies to ensure that they were appropriate and timely.
- Managed secondary review requests and processes pertaining to denials and potential denials as outlined by insurance carriers.
- Conducted reviews of inpatient utilization for compliance with admission criteria and concurrent review requirements.
Clinical Care Supervisor
Hennepin Healthcare
Minneapolis, MN
11.2015 - 10.2019
- Coordinated weekly work schedules for department employees.
- Maintained a safe work environment by adhering to safety protocols established by the organization.
- Developed educational materials regarding best practices in clinical care management for use by staff members.
- Implemented highly effective onboarding and coaching program for new and existing staff members and promoted cross-training in other areas.
- Enforced compliance with local, state and federal healthcare regulations, including Medicare and Medicaid requirements, HIPAA, OSHA and CLIA.
- Managed patient care and clinic services and handled financial management, quality assurance, safety and risk management and facility maintenance.
- Developed and implemented patient care plans based on physician orders, assessments, and evaluations.
- Encouraged high morale and staff retention through effective communication, prompt problem resolution, proactive supervisory practices and facilitation of proactive work environment.
- Enforced compliance with local, state and federal healthcare regulations, including Medicare and Medicaid requirements, HIPAA and OSHA.
- Provided guidance and support to medical personnel regarding clinical decisions related to patient care.
- Provided direct supervision of clinical staff including scheduling assignments, conducting performance reviews, evaluating job competency levels.
- Collaborated with community partners such as social service agencies and home health providers to coordinate resources for patients in need of additional support services.
- Collaborated with other professionals to assess client needs.
- Managed clinical operations and procedures and enforced adherence to federal and state regulations and healthcare law requirements.
- Ensured compliance with applicable laws, regulations, accreditation standards, policies and procedures related to clinical care management activities.
- Supervised 35 staff members and provided periodic performance evaluations.
- Communicated with patients and carefully explained important information regarding medications, procedures and physician instructions.
- Developed and initiated departmental goals, standards of performance, policies and procedures.
- Assessed physical and mental health needs of patients in order to develop individualized treatment plans.
- Oversaw clinical operations and procedures while remaining current of federal and state regulations to ensure organization processes were fully compliant with new healthcare law requirements.
- Educated patients on available resources for managing their conditions both inside and outside the facility setting.
- Introduced new departmental policies and oriented staff to facilitate adoption of changes.
Staff RN
Hennepin Healthcare
Minneapolis, MN
04.2013 - 11.2015
- Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
- Demonstrated expertise in the assessment, diagnosis, planning, implementation and evaluation of patient care.
- Administered oral, IV and intra-muscular medications and monitored patient reactions.
- Facilitated timely discharge planning activities by collaborating with social workers and case managers for appropriate placement and follow up instructions.
- Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
- Addressed rapid response and code situations by strategically organizing and delegating tasks.
- Answered patient questions and provided take-home materials for further information.
- Interpreted and evaluated diagnostic tests to identify and assess patient's condition.
- Responded quickly and effectively to life-saving situations using nursing standards and protocols for treatment.
- Performed various tests such as blood glucose monitoring, EKGs, wound dressings, phlebotomy and care according to established protocols.
Clinic RN
Hennepin Healthcare
Minneapolis, MN
10.2012 - 04.2013
- Prepared medical equipment and tools to aid physician during examination and treatment of patients.
- Educated patients and families about health promotion and disease prevention strategies.
- Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.
- Referred patients to specialized health resources or community agencies to furnish additional assistance.
- Counseled individuals regarding lifestyle choices that may affect their health status positively or negatively.
- Collaborated with multidisciplinary team members to ensure optimal patient outcomes.
- Interpreted and evaluated diagnostic tests to identify and assess patient's condition.
- Administered oral, IV and intra-muscular medications and monitored patient reactions.
- Delivered information regarding care and medications to patients and caregivers in comprehendible terminology.
- Provided emotional support to family members during stressful times related to illness or injury of loved ones under care.
- Coordinated timely refills for patients' prescriptions by obtaining authorizations and transmitting paperwork.
- Cared for clinic patients by administering medications and treatments for various conditions.
- Instructed patients and family members on medication and treatment instructions to promote adherence to guidelines.
- Performed laboratory tests such as urinalysis, blood draws, and other diagnostic tests according to established protocols.
- Promoted a safe environment for patients by adhering to infection control protocols.
- Collected blood samples using phlebotomy best practices and labeled specimens for testing.
- Assisted physicians during exams when needed.
Staff RN
Hennepin Healthcare
Minneapolis, MN
06.2012 - 10.2012
Case Manager
Cigna
Eden Prairie, MN
01.2012 - 06.2012
- Provided referrals to appropriate health care providers or other community resources.
- Provided case management services including intake, assessment, crisis intervention, advocacy, referral and monitoring of families.
- Educated clients about mental health conditions, medications and self-care techniques.
- Coordinated support services and optimized communication between healthcare workers and patients.
- Advocated for clients by obtaining information regarding treatment options and clinical status.
- Provided crisis intervention support for clients in emergency situations.
- Counseled clients on available resources within the community that could help meet their needs.
- Facilitated communication between clients, families, caregivers, social services and other agencies to ensure client needs were met.
- Transitioned clients to different providers based on progress or needs.
- Displayed strong telephone etiquette, effectively handling difficult calls.
- Approached customers and engaged in conversation through use of effective interpersonal and people skills.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
Staff RN
Hennepin Healthcare
Minneapolis, MN
09.2011 - 01.2012
Education
Bachelor of Science in Nursing -
Minnesota State University
Associate of Science in Nursing -
North Hennepin Community College
Bachelor of Arts in Criminal Justice -
University of St. Thomas
Skills
- Multitasking and Organization
- Decision-Making
- Phlebotomy
- Care Coordination
- Patient Education
- Chronic disease management
- Strong clinical judgment
- Case management
- Written and verbal communication
- Patient Assessments
- Interdisciplinary collaboration
- Analytical and Critical Thinking
Certification
Public Health Nurse, MN Board of Nursing
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Utilization Management Supervisor
Hennepin Health
06.2023 - 12.2023
Utilization Management Specialist RN
M Health Fairview
11.2020 - 02.2023
Utilization Management RN
North Memorial Health
11.2019 - 03.2020
Clinical Care Supervisor
Hennepin Healthcare
11.2015 - 10.2019
Staff RN
Hennepin Healthcare
04.2013 - 11.2015
Clinic RN
Hennepin Healthcare
10.2012 - 04.2013
Staff RN
Hennepin Healthcare
06.2012 - 10.2012
Case Manager
Cigna
01.2012 - 06.2012
Staff RN
Hennepin Healthcare
09.2011 - 01.2012
Bachelor of Science in Nursing -
Minnesota State University
Associate of Science in Nursing -
North Hennepin Community College
Bachelor of Arts in Criminal Justice -
University of St. Thomas
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