Sarah Cameron
Flint
Summary
Utilization Management Specialist experienced in healthcare and insurance industries. Achieved improved resource allocation and enhanced quality of care through effective utilization review procedures and collaboration with healthcare providers. Focused on optimizing patient care while ensuring regulatory compliance and fostering interdisciplinary teamwork.
Overview
7
7
years of post-secondary education
14
14
years of professional experience
Work History
Utilization Management Specialist ECC
Covenant HealthCare
Saginaw
10.2020 - Current
- Determined medical necessity and cost-effectiveness of services through utilization review processes.
- Reviewed patient records for appropriate utilization of healthcare services.
- Collaborated with clinical teams to assess treatment plans and resource needs.
- Coordinated with insurance providers for authorization of services and procedures.
- Collaborated with physicians, hospitals, and other providers to facilitate timely resolution of utilization management issues.
- Educated staff on best practices for utilization management processes.
- Provided feedback to healthcare providers on clinical documentation improvement to support utilization review.
RN Staff Nurse
Select Specialty Hospital LTAC
Saginaw
10.2018 - 05.2020
- Administered medications and monitored patient responses effectively.
- Provided direct patient care in a long-term acute care setting.
- Collaborated with healthcare teams to develop individualized patient care plans.
- Assessed client needs and developed personalized care plans for diverse populations.
- Coordinated services with healthcare providers, ensuring comprehensive support for clients.
- Monitored client progress and adjusted interventions based on ongoing evaluations.
- Educated clients and families about available resources and support systems.
- Collaborated with multidisciplinary teams to enhance service delivery and outcomes.
- Educated clients about available resources and how to access them effectively.
- Assessed client needs and developed individualized service plans to meet those needs.
- Collaborated with multidisciplinary teams to develop strategies for meeting clients' goals.
- Provided case management services including intake, assessment, crisis intervention, advocacy, referral and monitoring of families.
- Developed and maintained case management plans in accordance with agency policies and procedures.
- Identified potential barriers that could impede progress towards achieving desired outcomes while developing solutions to address them quickly and efficiently.
- Managed caseloads effectively, ensuring timely documentation and reporting.
- Maintained accurate documentation of case notes in the computer system according to regulations.
- Maintained confidentiality and adhered to professional ethics and standards.
- Identified barriers to client success and developed strategies to overcome them.
- Negotiated with insurance companies and other payers to secure coverage for client services.
- Participated in team meetings and professional development activities to stay current on best practices in case management.
- Consulted with staff on resolution of complex service issues.
RN Staff Nurse
Covenant HealthCare
Saginaw
06.2012 - 10.2018
- Monitored vital signs and initiated emergency response as needed for patients.
- Administered medications accurately according to physician orders.
- Delivered optimum treatments to critical-care patients following prescribed rules, policies, protocol, and procedures.
- Initiated life-saving measures when necessary such as cardiopulmonary resuscitation or emergency drug administration.
- Completed patient assessments, triaged and recorded patient histories, symptoms and observations.
- Facilitated communication between patients, families, and medical personnel effectively.
- Provided emotional support for patients and their families during difficult times.
- Acted as an advocate for patient rights while providing support, education and resources to families and caregivers regarding end-of-life decisions.
- Maintained accurate patient records and documentation according to hospital standards.
- Ensured compliance with hospital protocols and safety regulations during shifts.
- Utilized critical thinking skills to assess complex situations quickly and effectively.
- Achieved best possible outcomes for nursing sensitive indicators, core measures, HCAPS, patient satisfaction and associate satisfaction.
- Assisted physicians during medical procedures, including intubations, central line insertions and chest tube placements.
- Supervised nursing staff and coordinated patient care in critical situations.
- Precepted new staff nurses to provide education on hospital policies and procedures, patient care skills, medical procedures, and techniques and patient assessments and interventions.
- Instructed new nurses on proper techniques when caring for critically ill patients in the ICU setting.
- Served as a mentor for newly hired nurses by providing guidance on policies and procedures specific to ICU setting.
- Evaluated staffing levels throughout shift to ensure adequate coverage at all times.
- Developed and maintained professional relationship with members of health care team, patient, and patient's family.
- Reviewed lab results promptly upon receipt; notified physician if any abnormalities were noted.
- Demonstrated leadership skills by delegating duties appropriately among staff members.
- Demonstrated leadership skills by delegating duties appropriately among staff members.
Education
Bachelor of Science - Nursing
University of Kentucky
Lexington, KY 10.2019 - 05.2022
Associate of Applied Science - Nursing
Charles Stewart Mott Community College
Flint, MI 08.2003 - 12.2007
Swartz Creek High School
Swartz Creek, MISkills
- Utilization management
- Utilization review
- Necessity assessment
- Documentation improvement
- Critical thinking
- Interdisciplinary teamwork
- Effective communication
Timeline
Utilization Management Specialist ECC
Covenant HealthCare
10.2020 - Current
Bachelor of Science - Nursing
University of Kentucky
10.2019 - 05.2022
RN Staff Nurse
Select Specialty Hospital LTAC
10.2018 - 05.2020
RN Staff Nurse
Covenant HealthCare
06.2012 - 10.2018
Associate of Applied Science - Nursing
Charles Stewart Mott Community College
08.2003 - 12.2007
Swartz Creek High School