Work Preference
Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Work Availability
Timeline
Generic
Rachel Moore

Rachel Moore

NURSE
Tinley Park,IL

Work Preference

Desired Job Title

Registered NurseUtilization ReviewUnit Manager of Clinical OperationsTeam Lead, Utilization ReviewTransplant Coordinator, UM/CM III- II

Work Type

Full TimePart Time

Location Preference

On-SiteRemoteHybrid

Important To Me

Work-life balanceHealthcare benefitsCareer advancementPaid time off401k match

Summary

Healthcare professional committed to nursing leadership with track record of improving patient outcomes and staff performance. Known for enhancing operational efficiencies and implementing best practices. Reliable team collaborator focused on achieving results and adapting to evolving healthcare needs.

Overview

37
37
years of professional experience
1
1
Certification

Work History

Registered Nurse

American Mobile Healthcare-Travel Nursing
  • Facilities Worked
  • Lutheran General Hospital – PICU/Neonatal ICU/Mother-Baby
  • Lurie Children’s Hospital – PICU/Peds Transplant
  • Children’s Medical Center of Dallas – PICU/Neuro ICU
  • University of Chicago – PICU

Utilization Review

Non-Custom EMR – Electronic Medical Record Team
01.2023 - Current
  • Performing Initial & Concurrent review in accordance with approved NCQA/HB711 and departmental guidelines
  • HIGH RISK OB (HROB)
  • Predetermination for Surgical Procedures & Outpatient Services
  • Sleep Studies
  • Gastric Bypass
  • Gender Reassignment
  • Surgical Preauthorization

Unit Manager of Clinical Operations

Illinois Non-Custom-Fully Insured
05.2019 - 01.2023
  • Responsible for supervising clinical staff involved in a variety of clinical operations such as Utilization Management.
  • Responsible for hiring, training, performance reviews, pay administration, change management and ensuring staff meet/exceeds goals and initiatives.
  • Implement processes, procedures and initiatives and monitor results, ensure delivery of effective customer service, ensure department is meeting account contracts, and work across the organization in delivery of services to the customer.

Team Lead, Utilization Review

MCO-Regulated Small Group/HCSC
04.2016 - 05.2019
  • Conducting Monthly Staff Utilization Management Audits.
  • Performing concurrent review in accordance with approved URAC and departmental guidelines.
  • Provide medically necessary cost effective services and cost savings within the scope of the individuals’ benefit plan.

Transplant Coordinator, UM/CM III- II

Medical Management/HCSC
10.2012 - 04.2016
  • Review Medical Information and Medical Policies working in collaboration with Medical Management Team to assist with approval in request for transplantation.
  • Applied Case Management principles in coordinating resources necessary to meet individuals’ health needs.

Congenital Heart Clinic Nurse

Emory University Health Center
12.2010 - 10.2012
  • Assisting with patient referrals.
  • Triage patient calls
  • Reviewing diagnostic testing: eg: EKG results, 24 hr Holter Monitors, Lab results

Freelance Consultant

Brian’s Home Inc
07.2008 - 12.2008
  • Case Management: Medical Review prior to Audits of Home.

Resource Coordinator

Northwestern Memorial Hospital
08.2004 - 10.2004
  • Conducts orientation & training of new & existing staff.
  • Schedule staff for adequate coverage to meet dept needs.
  • Contains costs/ensuring the dept is providing the highest quality of service.
  • Enforces policies and procedures
  • Serves as a clinical resource to staff.

Registered Nurse

Advocate Aurora Health Care
01.1989 - 09.2004
  • Adult Cardiac Telemetry 1989-1994
  • Pediatric ICU/Neonatal ICU 1994-2004
  • Duties include but not limited to: Clinical bedside Nursing with a patient population with an age range of Newborn to 17years. Charge Nurse Duties/ICU Scheduler/Acting Departmental Educator/Trained the staff on the use of all new equipment from new Dialysis pumps to IV Infusion Pumps. / ICU Preceptor of new staff/ worked as Back-up Transport Nurse. PALS Educator & Certification.

01.1994 - 01.2002
  • Pediatric Surgical Heart 1994-2002: Worked with Pediatric Congenital Heart patients, ECMO Certified, developed relationships with families and patients to support and achieve health goals.
  • EMS Dept: Pediatric Paramedic Trainer: 2000-2002

Education

Bachelor of Science - NURSING

Purdue University
Hammond, IN

AAS - undefined

Prairie State College

Master of Science - Nursing

Chamberlain University
Tinley Park, IL
05-2027

Skills

  • HTML, Microsoft Office, Microsoft Excel, Microsoft Windows, Adobe
  • Precepting
  • EMR systems
  • Staff supervision
  • Case management
  • Clinical judgment
  • Nursing staff leadership
  • Process improvement
  • Staff training/development
  • Management team building
  • Payroll administration and timekeeping
  • Quality assurance

Accomplishments

  • Over 15 years of Registered Nurse experience.
  • Utilization Review/Care Coordination for Electronic Medical Records Team
  • Unit Manager of Clinical Operations: Direct reports have ranged from 10 – 20 people
  • New Hire Trainer as well as Team Leader for MCO Regulated Small Group.
  • 10 years with HCSC Blue Cross Blue Shield as a Care Coordinator/Utilization Review/Case Manager.
  • Worked closely with the quality department to help research and develop a more efficient way to increase the TAT (Turnaround Time) for reviewing Clinical information.
  • Supported the development of a new system platform
  • 1) Smart UM (SUM) Ambassador. Authorized by leadership to represent the team to answer Questions regarding the new application software platform.
  • 2) Part of the Pilot Program for Smart UM. Worked as part of a team testing the quality of the new application platform.
  • As Team Lead/responsible for Monthly Audits of Staff members (MCG Adherence Audits & UM IP Acute Audits).
  • In 10 years, managed several departments, Assisted with Education staff members regarding policies and procedures.
  • Assisted in Developing Training material for the Post-Acute Team ( LTAC, Rehab, SNF)
  • Culture Club Committee: Assist in enhancing the everyday culture of the workplace. The mission the mission of the group is to make work more productive and environmentally friendly place to be.
  • Peer Recognition Committee: The Mission of this committee is to encourage co-workers to recognize the effort that our peer does in helping us daily.

Certification

  • Certified Case Manager: #4211634
  • Diploma Legal Nurse Consultant:

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline

Utilization Review

Non-Custom EMR – Electronic Medical Record Team
01.2023 - Current

Unit Manager of Clinical Operations

Illinois Non-Custom-Fully Insured
05.2019 - 01.2023

Team Lead, Utilization Review

MCO-Regulated Small Group/HCSC
04.2016 - 05.2019

Transplant Coordinator, UM/CM III- II

Medical Management/HCSC
10.2012 - 04.2016

Congenital Heart Clinic Nurse

Emory University Health Center
12.2010 - 10.2012

Freelance Consultant

Brian’s Home Inc
07.2008 - 12.2008

Resource Coordinator

Northwestern Memorial Hospital
08.2004 - 10.2004

01.1994 - 01.2002

Registered Nurse

Advocate Aurora Health Care
01.1989 - 09.2004

Registered Nurse

American Mobile Healthcare-Travel Nursing

AAS - undefined

Prairie State College

Bachelor of Science - NURSING

Purdue University

Master of Science - Nursing

Chamberlain University

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