Samantha Oakes
Huntersville,NC
Summary
Results-driven healthcare leader and project management professional offering 10 years of clinical, administrative and patient care experience. Gifted in building and implementing approaches to increase quality and streamline procedures. Significant leadership background directing multidisciplinary healthcare teams to achieve care objectives and outperform business targets.
Overview
10
10
years of professional experience
Work History
Legal Nurse Consultant
Archer Services
07.2026 - Current
- Reviewed medical records to identify care gaps, inconsistencies, and case-relevant clinical issues.
- Summarized complex medical findings into clear, concise reports for attorneys and case teams.
- Contributed to workflow enhancements by assisting with the creation of a uniform review guide.
Utilization Management Supervisor
Molina Healthcare
11.2024 - 06.2026
- Supervised utilization management workflow to support timely review of prior authorization requests and medical necessity determinations.
- Reviewed cases for compliance with utilization management guidelines, policies, and regulatory requirements.
- Collaborated with interdisciplinary teams to address complex authorization and escalation issues.
- Trained staff on documentation standards, case processing expectations, and utilization review procedures.
- Monitored case queues to maintain consistency, accuracy, and appropriate routing of requests.
- Built SharePoint website centralizing available resources into single location.
Clinical Trainer
Molina Healthcare
05.2023 - 11.2024
- Built from ground-up virtual clinical training department covering all utilization and care management for NY Plan and created DEI/Cultural Competency series drawing national health plan attention.
- Enhanced skills by resourcing the Learning & Development corporate team for training on Storyline Articulate and the Cornerstone LMS.
- Operationalized hybrid project management model to produce agile deliverables with structured rollout of materials.
- Facilitated clinical training sessions on policies, procedures, and compliance requirements for diverse staff groups.
- Developed onboarding materials and refreshed curriculum to align with updated clinical workflows.
- Assessed learner competency through quizzes, observations, and coaching to reinforce accurate process execution.
- Collaborated with subject matter experts to clarify clinical content and maintain consistent training standards.
- Streamlined the training process by creating efficient schedules and organizational systems for resources.
Utilization Review Nurse
Molina Healthcare
02.2022 - 05.2023
- Assessed inpatient and outpatient cases for appropriate level of care and continued stay.
- Assessed inpatient and outpatient physical and behavioral health cases for appropriate level of care and continued stay.
- Communicated denials, approvals, and pend decisions to providers and care team members.
- Documented utilization review determinations in clinical systems with accuracy and consistency.
- Delivered coaching and training support to multidisciplinary staff through structured sessions.
- Assessed workflow bottlenecks, created process improvement plans, and presented recommendations.
Utilization Review Nurse
Fidelis Care
03.2019 - 07.2021
- Assessed MLTC/LTSS cases for appropriate level of care and continued stay.
- Coordinated with physicians, case managers, and members to support timely care transitions.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
Registered Nurse Care Manager
Fidelis Care
03.2019 - 10.2020
- Developed individualized care plans aligned with clinical guidelines and managed care requirements.
- Coordinated with physicians, specialists, and community resources to support timely member access.
- Conducted comprehensive member assessments to identify care needs and appropriate service coordination.
- Reviewed medical records and utilization data to ensure accurate care management decisions.
- Oriented and trained new hires on care management processes.
- Collaborated with senior staff and leadership to design an improved new hire orientation during the first 90 days of hire.
Visiting Nurse Case Manager
Albany Visiting Nurses Association
09.2018 - 03.2019
- Evaluated clinical status, identified changing needs, and updated care plans to support safe discharge outcomes.
- Coordinated patient-centered care plans across home health visits, referrals, and interdisciplinary communication.
- Collaborated with physicians, therapists, and social workers to align treatment goals and continuity of care.
- Monitored documentation accuracy for assessments, visit notes, and care coordination records.
- Delivered high-quality nursing services in compliance with regulatory requirements, organizational policies, and evidence-based practice guidelines.
Registered Nurse, Telemetry Unit
St Peter's Hospital
02.2017 - 09.2018
- Monitored cardiac rhythms and responded promptly to telemetry alarms.
- Assessed patients, identified changes in condition, and escalated concerns to providers.
- Administered medications and IV therapies while maintaining safe, accurate documentation.
- Coordinated interdisciplinary care plans to support complex telemetry patients.
- Educated patients and families on cardiac conditions, medications, and discharge instructions.
Education
Bachelor of Science - Nursing
Russell Sage College
Troy, NY12-2016
Skills
- Clinical workflow optimization
- Case management prioritization
- Clinical risk assessment
- Healthcare systems
- Project management
- Process improvement
- Agile methodology
- Backlog prioritization
- Risk evaluation
- Training facilitation
- Oral communication
- Clinical training development
Licenses and Certifications
Project Management Professional (PMP) Certification via PMI
North Carolina/Multi-State Compact Registered Nurse: 396118
New York State Registered Nurse: 727949
Timeline
Legal Nurse Consultant
Archer Services
07.2026 - Current
Utilization Management Supervisor
Molina Healthcare
11.2024 - 06.2026
Clinical Trainer
Molina Healthcare
05.2023 - 11.2024
Utilization Review Nurse
Molina Healthcare
02.2022 - 05.2023
Utilization Review Nurse
Fidelis Care
03.2019 - 07.2021
Registered Nurse Care Manager
Fidelis Care
03.2019 - 10.2020
Visiting Nurse Case Manager
Albany Visiting Nurses Association
09.2018 - 03.2019
Registered Nurse, Telemetry Unit
St Peter's Hospital
02.2017 - 09.2018
Bachelor of Science - Nursing
Russell Sage College