Samantha Sinek
Rochester,WA
Summary
Motivated utilization management nurse possessing skills in addressing and resolving conflicts to maintain team harmony and performance. Offers 5 years of UM experience leading talented teams and offering knowledgeable guidance and support. Background includes strong history in utilization review, oncology, and med-surg nursing.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Supervisor, Utilization Management
Centene/Coordinated Care Health Plan
Tacoma, Washington
10.2018 - Current
- Supervise the daily operations of the UM staff
- Ensure appropriate usage of resources in order to facilitate the UM process
- Ensure compliance within applicable state program guidelines
- Played a key role ensuring compliance with regulatory requirements, policies, and procedures
- Assist with ensuring consistent data collection from UM staff that is used to assist the company in achieving corporate goals, to improve monitoring and reporting in order to meet external requirements
- Educate staff as necessary to ensure consistent performance and adhere to standards.
Resource Nurse/Concurrent Review Nurse II/Utilization Management
Centene/Coordinated Care Health Plan
Tacoma, Washington
10.2018 - 06.2022
- Performed medical necessity review that includes inpatient, prospective, and retrospective review to ensure compliance with applicable criteria, medical policy, member eligibility, benefits, and member contract
- Consulted with Medical Directors when care does not meet applicable criteria or medical policies
- Meet or exceeded production and quality metrics
- Ensures the delivery of optimal care for our patients while promoting fiscal responsibility
- Reviewed, researched, and prepared initial, 1st, and 2nd level appeals for all Potentially Preventable Readmissions
- Identified and coordinated services both internally and externally; interacted extensively with case managers and outside facilities to determine follow-up care needs for discharged patients.
Staff Infusion Nurse
Multicare Regional Cancer Center
Tacoma, Washington
02.2015 - 10.2018
- Education of patients and families regarding new chemotherapies, potential side effects, symptom management, nutritional counseling, and reportable symptoms
- Accessed implanted ports, performed venipunctures, and operated catheter devices
- Monitoring of lab values and diagnostic tests
- Management of oncologic emergencies
- Infused Chemotherapies of all types.
Lead Oncology Care Coordinator – Lead Clinic RN
Valley Oncology and Hematology Clinic
Renton, Washington
05.2011 - 02.2015
- Epic super user
- Oversaw quality audits, hiring of new staff, and procedural departmental reports
- Maintained quality assurance and continuous improvement programs to monitor for health and safety compliance and infection control within the clinic
- Provided health education, promotion and counseling to patients, including their families.
Staff Nurse – Oncology/Medical-Surgical
Good Samaritan Hospital
Puyallup, Washington
09.2010 - 04.2011
Staff Nurse – Oncology/Medical-Surgical
St. Joseph’s Medical Center
Tacoma, Washington
04.2009 - 07.2010
- Responsible for day to day treatment plans of 5-6 patients per day in a 28-bed adult unit
- Collaborated effectively with all interdisciplinary team members to ensure safe and quality care for patients
- Provided a broad range of general nursing care services in areas of vital signs, telemetry, catheters, feeding tubes, IV, peripheral, and central lines.
Education
Associate of Science in Nursing -
Tacoma Community College
01.2008
Associate of General Studies -
Central Texas College
01.2005
Skills
- Process Improvement
- Employee Motivation
- Process Monitoring and Improvement
- Complex Problem-Solving
Certification
Washington, 60038059, Registered Nurse License
Timeline
Supervisor, Utilization Management
Centene/Coordinated Care Health Plan
10.2018 - Current
Resource Nurse/Concurrent Review Nurse II/Utilization Management
Centene/Coordinated Care Health Plan
10.2018 - 06.2022
Staff Infusion Nurse
Multicare Regional Cancer Center
02.2015 - 10.2018
Lead Oncology Care Coordinator – Lead Clinic RN
Valley Oncology and Hematology Clinic
05.2011 - 02.2015
Staff Nurse – Oncology/Medical-Surgical
Good Samaritan Hospital
09.2010 - 04.2011
Staff Nurse – Oncology/Medical-Surgical
St. Joseph’s Medical Center
04.2009 - 07.2010
Associate of Science in Nursing -
Tacoma Community College
Associate of General Studies -
Central Texas College
Washington, 60038059, Registered Nurse License
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