Nicole Luke
Cedar City
Summary
Reliable individual bringing 25 years of experience in healthcare environments. Maintains positive relationships with case managers and providers. Remains polished and calm under extreme stress.
Overview
9
9
years of professional experience
Work History
Director of Utilization Review
Zealie LLC
11.2018 - Current
- Enhanced utilization review efficiency by streamlining processes and implementing new software tools.
- Reduced administrative burden for staff members through automating routine tasks and optimizing workflows.
- Developed targeted training programs to improve team performance and expertise in utilization review procedures.
- Collaborated with interdisciplinary teams, ensuring timely and accurate completion of utilization reviews for optimal patient care.
- Championed a culture of continuous learning by providing regular feedback on staff performance and offering opportunities for further skill development.
- Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
- Designed and introduced leadership development, coaching and team management model, resulting in promotion of employees into increased levels of responsibility.
Appeals Coordinator
Efficient Optimized Billing
12.2017 - 11.2018
- Enhanced appeal resolution rates by thoroughly reviewing and analyzing case documentation.
- Streamlined appeals process for increased efficiency through consistent tracking and monitoring of cases.
- Collaborated with cross-functional teams, resulting in improved communication and quicker resolutions.
- Maintained comprehensive knowledge of regulatory guidelines to ensure compliance within the appeals department.
Appeals Coordinator
R&O Consulting
08.2016 - 12.2017
- Enhanced appeal resolution rates by thoroughly reviewing and analyzing case documentation.
- Streamlined appeals process for increased efficiency through consistent tracking and monitoring of cases.
- Developed strategic action plans to address identified issues, leading to a reduction in appeals backlog.
- Conducted detailed audits on case files, ensuring accuracy and completeness of information for better decision making.
- Monitored changes in regulations or policies, updating internal procedures accordingly to maintain compliance.
Utilization Review Manager
Sure Haven
09.2014 - 08.2016
- Improved patient care quality by implementing utilization review processes and ensuring adherence to industry standards.
- Reduced costs through efficient management of medical resources and implementation of cost-effective strategies.
- Increased staff efficiency with effective delegation, supervision, and performance evaluation of team members.
- Developed comprehensive staff training programs to enhance employees'' understanding of utilization review principles and practices.
- Streamlined communication between interdisciplinary teams, fostering collaboration for improved patient outcomes.
Education
Certificate - Medical Insurance Billing
Larson Training Center
Orange, CASkills
- Documentation Review
- Regulatory Compliance
- Decision Making
- Problem Solving
- Health Information Systems
- Resource Allocation
- Data Analysis
- Critical Thinking
Timeline
Director of Utilization Review
Zealie LLC
11.2018 - Current
Appeals Coordinator
Efficient Optimized Billing
12.2017 - 11.2018
Appeals Coordinator
R&O Consulting
08.2016 - 12.2017
Utilization Review Manager
Sure Haven
09.2014 - 08.2016
Certificate - Medical Insurance Billing
Larson Training Center