Summary
Overview
Work History
Education
Skills
Timeline
Generic

Rebecca Williams

Weatherford,TX

Summary

Hands-on professional proudly offering more than 28 years of expertise in nursing field. Well-rounded and personable Utilization Review Nurse talented in reporting, records oversight and performance improvement. Dependable Team Lead on a national team that encourages learning, quality, efficiency and excellence.

Overview

28
28
years of professional experience

Work History

Team Lead Utilization Management Nurse Consultant

Aetna/CVS
10.2013 - Current
  • Improved team productivity by implementing efficient project management strategies and streamlining communication channels.
  • Enhanced overall team performance by providing regular coaching, feedback, and skill development opportunities.
  • Led cross-functional teams for successful project execution while maintaining strong collaboration among team members.
  • Increased customer satisfaction by ensuring timely completion of projects and adherence to high-quality standards.
  • Developed and maintained effective relationships with key stakeholders to better understand their needs and expectations.
  • Managed risks and mitigated potential issues through proactive planning, monitoring, and timely decisionmaking.
  • Promoted a positive work environment by fostering teamwork, open communication, and employee recognition initiatives.
  • Optimized resource allocation by analyzing team member skills and project requirements, resulting in increased efficiency.
  • Implemented process improvements that led to reduced turnaround times for critical tasks without compromising quality.
  • Created detailed project plans outlining goals, timelines, resources, and budgets to ensure alignment with company objectives.
  • Conducted regular progress reviews with individual team members to identify areas for improvement and provide guidance on career development opportunities.
  • Collaborated with other department leads to streamline workflows, improve interdepartmental coordination, and achieve business goals collectively.
  • Established clear performance metrics for the team which helped in tracking progress towards set targets effectively.
  • Influenced positive change within the organization through strategic thinking, innovation, problem-solving abilities, and consistent leadership style.
  • Spearheaded multiple high-impact projects simultaneously while meeting tight deadlines under pressure-packed situations.
  • Championed continuous improvement initiatives that resulted in optimized processes leading to cost savings for the organization.
  • Explored new tools and technologies that enhanced the capabilities of the team members while enabling seamless collaboration across departments.
  • Nurtured long-term partnerships with clients by understanding their needs accurately, delivering projects on time, and providing exceptional customer support.
  • Served as a role model for the team by demonstrating commitment to excellence, professionalism, and adherence to company values at all times.
  • Developed succession planning strategies to ensure continuity of leadership within the team and facilitate smooth transitions during organizational changes.
  • Coached team members in techniques necessary to complete job tasks.
  • Worked different stations to provide optimal coverage and meet production goals.
  • Trained new team members by relaying information on company procedures and safety requirements.
  • Evaluated employee skills and knowledge regularly, training, and mentoring individuals with lagging skills.
  • Minimized resource and time losses by addressing employee or production issue directly and implementing timely solutions.
  • Managed schedules, accepted time off requests and found coverage for short shifts.
  • Directed and supervised team of 12 engaging in precertification/ post acute care management and skill development.
  • Designed strategic plan for component development practices to support future projects.
  • Monitored team performance and provided constructive feedback to increase productivity and maintain quality standards.
  • Supervised team members to confirm compliance with set procedures and quality requirements.
  • Built strong relationships with customers through positive attitude and attentive response.
  • Worked with team to identify areas of improvement and devised solutions based on findings.
  • Established open and professional relationships with team members to achieve quick resolutions for various issues.
  • Conducted training and mentored team members to promote productivity, accuracy, and commitment to friendly service.
  • Promoted high standards through personal example to help each member understand expected behaviors and standards.
  • Mentored and guided employees to foster proper completion of assigned duties.
  • Conducted training and mentored team members to promote productivity and commitment to friendly service.
  • Held weekly team meetings to inform team members on company news and updates.
  • Monitored time and attendance, enforcing compliance with company procedures relating to absenteeism.
  • Reviewed, implemented and updated company records related to team activities for future reference.
  • Maintained overall safe work environment with employee training programs and enforcement of safety procedures.
  • Optimized customer experience by delivering superior services and effectively troubleshooting issues.
  • Collected, arranged, and input information into database system.
  • Evaluated customer needs and feedback to drive product and service improvements.
  • Gathered, organized and input information into digital database.
  • Educated staff on organizational mission and goals to help employees achieve success.
  • Evaluated staff performance and provided coaching to address inefficiencies.
  • Conducted regular reviews of operations and identified areas for improvement.
  • Developed effective improvement plans in alignment with goals and specifications.
  • Helped meet changing demands by recommending improvements to business systems or procedures.
  • Generated reports detailing findings and recommendations.
  • Developed and updated tracking spreadsheets for process monitoring and reporting.
  • Maintained database systems to track and analyze operational data.
  • Provided reporting for forecast analysis and ad-hoc reporting in support of decision-making.
  • Enhanced patient care by conducting thorough reviews of medical records and assessing appropriate utilization of services.
  • Reduced healthcare costs by identifying potential overuse and misuse of medical resources.
  • Improved interdisciplinary communication by effectively collaborating with physicians, case managers, and other healthcare professionals.
  • Streamlined the preauthorization process for patients receiving specialty services, ensuring timely access to necessary care.
  • Supported evidence-based decision making through research and application of current industry guidelines for utilization management.
  • Optimized resource allocation by evaluating medical necessity for inpatient admissions and outpatient procedures.
  • Increased efficiency within the department by implementing new workflow processes to improve productivity and reduce turnaround times for case reviews.
  • Educated providers on best practices in utilization management, promoting a culture of continuous improvement and cost containment.
  • Conducted ongoing evaluations of clinical documentation, ensuring accurate representation of patient needs and appropriate billing practices.
  • Ensured compliance with regulatory requirements through consistent adherence to established policies and procedures for utilization management nursing practice.
  • Minimized readmissions by providing comprehensive discharge planning and coordinating post-acute care services for high-risk patients.
  • Strengthened peer review processes by participating in quality assurance initiatives aimed at improving overall patient outcomes.
  • Developed training materials for newly hired Utilization Management Nurse Consultants, facilitating a smooth transition into their roles.
  • Assisted with the development of performance metrics to track success rates within the Utilization Management department, driving continuous improvement efforts.
  • Served as a subject matter expert on internal committees focused on reviewing complex cases requiring specialized clinical knowledge or expertise.
  • Demonstrated flexibility in adapting to evolving organizational needs while maintaining focus on achieving key objectives related to cost containment and quality improvement measures.
  • Leveraged clinical expertise to provide guidance and support for nursing staff in addressing complex patient care issues requiring utilization management intervention.
  • Championed a collaborative approach to problem-solving, fostering strong relationships with peers and interdisciplinary teams within the organization.
  • Mentored junior team members, sharing best practices in utilization management nursing practice to facilitate professional growth and optimize overall team performance.
  • Performed prior authorization review of services requiring notification.
  • Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
  • Submitted cases for criteria failures and helped facilitate resolutions and approvals.
  • Performed admission reviews based for medical necessity based upon Millimen criteria specification.
  • Supervised and maintained all utilization review documentation through Meditech, Epic, Ecin
  • Served as subject matter resource, providing information related to Utilization Management and air transport processes.
  • Devise or identify solutions for irregular requests and issues.
  • Facilitated workgroup meetings with medical personnel to find effective solutions to issues.
  • Evaluated patient histories, complaints, and current symptoms.
  • Communicated with healthcare team members to plan, implement and enhance treatment strategies.
  • Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
  • Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
  • Managed patients recovering from medical or surgical procedures.
  • Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
  • Provided exceptional care to high-acute patients needing complex care such as ventilator management, extensive wound care and rehabilitation.
  • Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.
  • Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
  • Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities.
  • Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
  • Implemented care plans for patient treatment after assessing physician medical regimens.
  • Observed and documented patient factors such as diets, physical activity levels and behaviors to understand conditions and effectively modify treatment plans.
  • Delivered high level of quality care to diverse populations while overseeing patient admission and triaging based on acuity and appropriate department admission.
  • Recorded details regarding therapies to keep patient charts updated.
  • Collaborated with leadership to devise initiatives for improving nursing satisfaction, retention and morale.
  • Participated in evidence-based practice project implementation, nursing competency development and nursing simulation activities.
  • Led teams in driving successful patient outcomes by prioritizing standard of care and best practices.
  • Leveraged feedback and process improvement opportunities to create safer and healthier environment and increase patient satisfaction.

RN Patient Navigator

Southwest Nursing & Rehabilitation Center
09.2012 - 09.2013
  • Improved patient outcomes by providing high-quality nursing care and implementing evidence-based practices.
  • Enhanced patient satisfaction through effective communication, empathy, and timely response to their needs.
  • Collaborated with interdisciplinary teams for comprehensive patient care plans, resulting in better health outcomes.
  • Educated patients on disease management and self-care techniques, promoting lifestyle changes for improved health.
  • Managed complex cases of critically ill patients, ensuring optimal treatment plans were executed effectively.
  • Developed strong relationships with patients'' families, providing emotional support while addressing concerns or questions about care plans.
  • Assessed patient conditions promptly upon admission to determine appropriate interventions and prioritize care needs.
  • Devised individualized care plans tailored to each patient''s unique situation, optimizing clinical outcomes.
  • Aligned nursing goals with department objectives to enhance overall performance metrics within the healthcare facility.
  • Participated in professional development opportunities regularly to stay current on best practices in the field of nursing.
  • Served as a liaison between physicians and patients'' families to facilitate clear communication regarding treatment options and progress updates.
  • Coordinated discharge planning efforts with social workers, case managers, and other multidisciplinary team members for smooth transitions posthospitalization.
  • Championed quality improvement initiatives within the unit by identifying areas for improvement and implementing evidence-based strategies.
  • Managed patient caseloads effectively, ensuring timely interventions and thorough follow-ups to mitigate potential complications.
  • Provided emotional support to patients during challenging times, fostering a sense of trust and rapport that contributed to better overall wellbeing.
  • Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
  • Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
  • Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
  • Managed care from admission to discharge.
  • Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
  • Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
  • Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.
  • Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use, and disease management.
  • Maintained quality care and comfort for patients with heart failure, pulmonary hypertension, and other conditions.
  • Audited charts and reviewed clinical documents to verify accuracy.
  • Communicated with healthcare team members to plan, implement and enhance treatment strategies.
  • Educated family members and caregivers on patient care instructions.
  • Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
  • Managed patients recovering from medical or surgical procedures.
  • Implemented care plans for patient treatment after assessing physician medical regimens.
  • Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
  • Recorded details regarding therapies to keep patient charts updated.
  • Trained new employees on effective patient navigation techniques, ensuring continuity of care across the organization.
  • Fostered strong relationships with local service organizations to expand available resources for patient referrals.
  • Served as an advocate for vulnerable populations within the healthcare system, addressing disparities in access to care and treatment outcomes.
  • Participated in case conferences with interdisciplinary teams to review patient progress and adjust interventions as needed.
  • Ensured seamless transitions between levels of care by coordinating appointments, referrals, insurance authorizations, and follow-up communication.
  • Contributed to the ongoing development of best practices for patient navigation by staying current on industry trends, research findings, and professional development opportunities.
  • Participated in regular team meetings, huddles, staff meetings and quality improvement projects to improve patient care.
  • Consulted with medical staff and ancillary department to eliminate barriers to delivery of care and identified service delivery problems and potential for patient management intervention.
  • Worked with patients to ascertain issues and make referrals to appropriate specialists.

RN Case Manager

Texas Health Resources Southwest
01.2008 - 09.2012
  • Enhanced patient care by developing comprehensive care plans and coordinating with interdisciplinary healthcare teams.
  • Reduced hospital readmission rates through effective case management and patient education on self-care techniques.
  • Optimized resource utilization by identifying opportunities for cost containment while maintaining quality of care.
  • Improved patient satisfaction scores by providing timely follow-ups and addressing concerns promptly.
  • Streamlined discharge planning processes, ensuring a smoother transition for patients back to their homes or other facilities.
  • Collaborated closely with physicians to develop individualized treatment plans, supporting optimal patient outcomes.
  • Mentored new nursing staff, facilitating a faster learning curve and increased overall team efficiency.
  • Conducted thorough assessments of patients'' needs, enabling more accurate diagnoses and targeted interventions.
  • Served as a key liaison between patients, families, and healthcare providers, fostering open communication and trust among all parties involved in the care process.
  • Implemented evidence-based practices to improve overall clinical performance and patient outcomes.
  • Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
  • Promoted adherence to treatment plans by conducting regular follow-up visits and providing ongoing support to patients.
  • Participated in quality improvement initiatives aimed at enhancing the delivery of nursing care within the organization.
  • Navigated regulatory requirements effectively, ensuring proper documentation and compliance with relevant laws and guidelines.
  • Advocated for patients'' rights and preferences, working diligently to align care with individual values and goals.
  • Assisted in the development of policies and procedures that improved the efficiency of case management processes within the organization.
  • Provided emotional support to patients coping with chronic illness or end-of-life decisions, fostering resilience during difficult times.
  • Evaluated the effectiveness of implemented interventions periodically, adjusting treatment plans as needed to promote optimal patient outcomes.
  • Educated patients and families on available community resources, facilitating access to necessary support services.
  • Coordinated care conferences with interdisciplinary team members, ensuring all perspectives were considered in the development of comprehensive treatment plans.
  • Educated patients and caregivers on healthcare protocols and processes.
  • Managed support services and fostered communication among social workers, therapists, hospital staff, and patients.
  • Collaborated with healthcare leaders and physicians to support and offer resources in performance of duties to maintain high-quality and efficient patient care.
  • Developed and modified patient care plans and assisted interdisciplinary team in identifying client needs and goals to determine priorities of care.
  • Analyzed patient responses to medications, therapies and variances in plans of care.
  • Implemented aspects of patient care under physician orders and sought clarification when needed to promote safety, quality and cost-efficient care.
  • Increased referral rates by providing excellent service and building meaningful relationships with patients and caregivers.
  • Gathered and recorded patient health information and data to assess, identify and manage characteristics that affect care outcome.
  • Observed, monitored and reported changes in patient condition to supervising RN or physician in accordance with policies and procedures of medical facility.
  • Conducted preoperative risk assessments, ongoing assessments and evaluations to prepare patients for surgery and manage healing process.
  • Fostered partnerships to increase patient influx and facilitate hospital development.
  • Evaluated patient histories, complaints, and current symptoms.
  • Communicated with healthcare team members to plan, implement and enhance treatment strategies.
  • Educated family members and caregivers on patient care instructions.
  • Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
  • Managed patients recovering from medical or surgical procedures.
  • Provided exceptional care to high-acute patients needing complex care such as ventilator management, extensive wound care and rehabilitation.
  • Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.
  • Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
  • Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities.
  • Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
  • Implemented care plans for patient treatment after assessing physician medical regimens.
  • Developed Case Management resource manual for training new oncoming Case Managers.
  • Produced video teaching surgical patients what to expect post-operatively regarding discharge planning.

Director of Marketing

Main Street Home Health And Hospice
06.2007 - 01.2008
  • Boosted brand awareness by implementing targeted marketing campaigns and strategic partnerships.
  • Developed comprehensive marketing plans for product launches, resulting in increased sales and market share.
  • Managed cross-functional teams to execute successful marketing initiatives, enhancing company reputation and customer engagement.
  • Cultivated strong relationships with industry influencers and media outlets, securing positive coverage and maximizing brand exposure.
  • Streamlined internal processes for greater efficiency within the marketing department, allowing for increased focus on strategic initiatives.
  • Negotiated favorable contracts with vendors and agencies, reducing costs while maintaining high-quality results.
  • Launched innovative experiential marketing campaigns that drove customer engagement and generated buzz around new products or services.
  • Regularly presented marketing insights and recommendations to executive leadership, ensuring alignment with overall business objectives.
  • Devised marketing plans using digital strategies, print advertising, and word of mouth tactics.
  • Planned and executed events and marketing programs to increase qualified leads.
  • Boosted brand awareness and generated leads while managing internal and external marketing campaigns and programs.

Utilization/RN Case Manager

Plaza Medical Center
06.2000 - 06.2007
  • Enhanced patient care by developing comprehensive care plans and coordinating with interdisciplinary healthcare teams.
  • Reduced hospital readmission rates through effective case management and patient education on self-care techniques.
  • Optimized resource utilization by identifying opportunities for cost containment while maintaining quality of care.
  • Streamlined discharge planning processes, ensuring a smoother transition for patients back to their homes or other facilities.
  • Collaborated closely with physicians to develop individualized treatment plans, supporting optimal patient outcomes.
  • Conducted thorough assessments of patients'' needs, enabling more accurate diagnoses and targeted interventions.
  • Served as a key liaison between patients, families, and healthcare providers, fostering open communication and trust among all parties involved in the care process.
  • Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.

Registered Nurse

Care Now
12.1995 - 07.2000
  • Enhanced patient satisfaction by providing compassionate, holistic nursing care that addressed physical, emotional, and spiritual needs.
  • Streamlined medication administration processes for increased safety and accuracy during busy shifts.
  • Collaborated with interdisciplinary teams to develop comprehensive treatment plans for complex patients with multiple comorbidities.
  • Prevented the spread of infections by consistently adhering to strict infection control protocols and educating patients on proper hygiene practices.
  • Assisted in the training and mentorship of new nursing staff members, contributing to a positive work environment and high-quality patient care.
  • Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
  • Promoted a culture of safety within the healthcare facility by participating in quality improvement initiatives, identifying potential hazards, and advocating for best practices in nursing care delivery.
  • Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
  • Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
  • Administered medications via oral, IV, and intramuscular injections and monitored responses.
  • Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
  • Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
  • Provided direct patient care, stabilized patients, and determined next course of action.
  • Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.

Telemetry Registered Nurse

Plaza Medical Center
01.1997 - 06.2000
  • Enhanced patient care by accurately interpreting cardiac monitor readings and promptly reporting critical findings to healthcare team.
  • Decreased patient complications through diligent monitoring of vital signs, lab results, and other telemetry data.
  • Collaborated with interdisciplinary healthcare teams to develop and implement individualized care plans for patients with complex conditions.
  • Improved patient outcomes by providing comprehensive education on medications, procedures, and lifestyle modifications.
  • Streamlined communication between nursing staff and physicians, ensuring timely intervention for urgent issues.
  • Facilitated seamless transitions of care from ICU to telemetry unit by coordinating necessary equipment, resources, and personnel.
  • Administered prescribed medications safely and effectively while closely monitoring potential side effects or adverse reactions.
  • Increased patient satisfaction scores through attentive listening, empathetic support, and timely addressing of concerns.
  • Optimized workflow efficiency within the unit by prioritizing tasks according to urgency and collaborating with fellow nurses during peak periods of activity.
  • Demonstrated commitment to professional growth through ongoing participation in continuing education courses, seminars, and conferences related to telemetry nursing best practices.
  • Prevented life-threatening complications by quickly recognizing early warning signs of deterioration in critically ill patients under close observation.
  • Enhanced teamwork within the telemetry unit through active participation in daily huddles, shift handoffs, and collaborative problem-solving sessions.

Education

Associate of Applied Science - Nursing Science

Tarrant County College District
Fort Worth, TX
12.1995

Associate of Arts - Liberal Arts And General Studies

Tarrant County College District
Fort Worth, TX
12.1995

Skills

  • Trend Tracking
  • Performance Monitoring
  • Regulatory Compliance
  • Production Monitoring
  • Schedule Management
  • Complaint Resolution
  • Resource Allocation
  • Employee Evaluation
  • Key Performance Indicators
  • Performance Improvement
  • Quality Control
  • Task prioritization
  • Team building
  • Conflict resolution
  • Risk management
  • Relationship building
  • Adaptability
  • Influencing skills
  • Effective communication
  • Problem solving
  • Goal setting
  • Organizational skills
  • Diversity and inclusion
  • Coaching and mentoring
  • Decision making
  • Process improvement
  • Critical thinking
  • Time management
  • Public speaking
  • Training and development
  • Creative thinking
  • Change management
  • Quality assurance
  • Quality Improvement
  • Documentation and Reporting
  • Coaching
  • Mentoring
  • Shift Scheduling
  • Team Supervision
  • Attention to Detail
  • Work Planning and Prioritization
  • Onboarding and Orientation
  • Giving Constructive Feedback
  • Analytical Thinking
  • Evaluating Employee Work
  • Leading Team Meetings
  • Complex Problem-Solving
  • Excel Census reporting
  • Contract review
  • Reviewing medical record for appropriate level of care
  • Documentaction
  • Use of Excel, Millimen, Epic, Pegareach, Canopy, Word, Doc Find, Windows, Ecin
  • Teaching processes
  • DRG'S, ICD 10 coded, HCPC codes
  • Culture Advocate Committee

Timeline

Team Lead Utilization Management Nurse Consultant

Aetna/CVS
10.2013 - Current

RN Patient Navigator

Southwest Nursing & Rehabilitation Center
09.2012 - 09.2013

RN Case Manager

Texas Health Resources Southwest
01.2008 - 09.2012

Director of Marketing

Main Street Home Health And Hospice
06.2007 - 01.2008

Utilization/RN Case Manager

Plaza Medical Center
06.2000 - 06.2007

Telemetry Registered Nurse

Plaza Medical Center
01.1997 - 06.2000

Registered Nurse

Care Now
12.1995 - 07.2000

Associate of Applied Science - Nursing Science

Tarrant County College District

Associate of Arts - Liberal Arts And General Studies

Tarrant County College District

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Rebecca Williams