Shannon Hostetter
Alamosa,CO
Summary
With a proven track record at Advantasure, I excel in HIPAA compliance and effective communication, ensuring optimal healthcare outcomes. Leveraging skills in healthcare regulations and discharge planning, I've enhanced patient care coordination and data security, embodying a commitment to excellence and patient advocacy.
Overview
1
1
year of professional experience
Work History
Utilization Review Nurse
Advantasure
09.2024 - Current
- Analyzed data from patient surveys, interviews and other sources to assess healthcare service quality.
- Determined medical necessity and cost-effectiveness of services through utilization review processes.
- Reviewed and updated utilization review criteria and guidelines to reflect current standards of practice.
- Conducted reviews of inpatient utilization for compliance with admission criteria and concurrent review requirements.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Utilized evidence-based guidelines to support utilization review decisions and recommendations.
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
- Referred cases to secondary review for failure to meet criteria.
- Interpreted and evaluated diagnostic tests to identify and assess patient's condition.
- Assessed patient medical records to determine the appropriateness of requested services and procedures.
- Maintained up-to-date knowledge of health plan benefits, policies, procedures, regulations, coding guidelines.
- Monitored pre-authorization requests to ensure that all necessary information was received prior to approval or denial of services.
- Monitored patient admissions and discharges to optimize care coordination and resource utilization.
- Conducted comprehensive reviews of patient records to ensure medical necessity and compliance with healthcare standards.
- Performed discharge planning including referrals for post-acute care services when appropriate.
- Facilitated communication between payers, providers and patients concerning authorization issues or concerns.
- Performed pre-certification, concurrent, and retrospective reviews of inpatient and outpatient services.
Registered Nurse
Advantasure
02.2024 - Current
- Conducted intake assessments with patients and relatives to gather case history.
- Interpreted and evaluated diagnostic tests to identify and assess patient's condition.
- Advocated for patients by supporting and respecting basic rights, values, and beliefs.
- Provided patient and family health education focusing on self-management, prevention and wellness.
- Assessed patient needs, prioritized treatment, maintained patient flows and assisted physicians with non-invasive procedures.
- Provided patient care and education to patients with chronic illnesses.
- Coordinated with healthcare team to establish, enact and evaluate patient care plans.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Utilized critical thinking skills to assess clinical situations quickly and accurately.
- Collaborated with doctors to plan post-treatment home care and prevent return hospitalization.
- Provided emotional support and counseling to patients and their families.
- Educated patients and families on health care needs, conditions, and options.
- Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
- Counseled patients regarding medication side effects or lifestyle changes necessary for improved health outcomes.
- Maintained thorough, accurate and confidential documentation in electronic medical records.
Education
Bachelor of Science -
UCCS
Colorado Springs, CO05-1999
Skills
- Communication
- HIPAA compliance
- Healthcare regulations
- Documentation and reporting
- Discharge planning coordination
- Medicare
Timeline
Utilization Review Nurse
Advantasure
09.2024 - Current
Registered Nurse
Advantasure
02.2024 - Current
Bachelor of Science -
UCCS
Similar Profiles
Austen JoeckelAusten Joeckel
Operational Data Analyst I at AdvantasureOperational Data Analyst I at Advantasure
Aditya KoneruAditya Koneru
Sr DevOps Engineer at AdvantasureSr DevOps Engineer at Advantasure
Roslynn TurnerRoslynn Turner
Provider Engagement Coordinator at AdvantasureProvider Engagement Coordinator at Advantasure
Tina WheelerTina Wheeler
Early Intervention Service Coordinator at Blue Peaks Developmental ServicesEarly Intervention Service Coordinator at Blue Peaks Developmental Services
Marina FesehaMarina Feseha
ASU Counseling Center Intern at Adams State UniversityASU Counseling Center Intern at Adams State University