Sharon Main Stevenson
Vevay,IN
Summary
Healthcare professional with extensive experience in utilization review and commitment to optimizing healthcare resource management. Adept at driving process improvements and enhancing patient care outcomes through strategic review protocols. Known for collaborative leadership and adaptability in dynamic healthcare settings, ensuring team cohesion and consistent results.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Director of Utilization Review
UC Health
09.2018 - Current
- Conducted comprehensive audits of past utilization reviews, identifying areas for improvement and implementing corrective actions.
- Oversaw the recruitment and onboarding of new team members, ensuring they were well-equipped to succeed in their roles within the department.
- Reduced administrative burden for staff members through automating routine tasks and optimizing workflows.
- Developed targeted training programs to improve team performance and expertise in utilization review procedures.
- Leveraged data analytics to identify trends in patient care needs, supporting informed decision-making within the department.
- Implemented cost-saving measures without compromising quality of care by closely monitoring the use of resources during the review process.
- Championed a culture of continuous learning by providing regular feedback on staff performance and offering opportunities for further skill development.
- Promoted transparency by creating user-friendly reports detailing departmental metrics, trends, and areas requiring improvement.
- Coordinated efforts between clinical staff, case managers, and insurance companies to ensure efficient communication throughout the review process.
Denial Prevention Coordinator
Bottom Line Systems Revecore
03.2014 - 09.2018
- Medical necessity appeals
- Critical thinking and auditing of documentation
- Analyze medical records to validate medical necessity and billing for services, tests, supplies
- Research commercial and governmental carrier policies, clinical abstracts, and evaluate denied claims-Interqual/MCG
- DRG/coding reviews
- Identified patterns in payer denials, implementing corrective actions to prevent future occurrences.
- Conducted root cause analyses of recurring denials, identifying areas for improvement within the organization''s processes and systems.
- Developed training materials and conducted workshops for staff on best practices in denial management.
Education
Bachelor of Science - Nursing
Cleveland State University
Cleveland Ohio05-2004
Skills
- Documentation review
- Quality improvement
- Healthcare operations
- Health information systems
- HIPAA compliance
- Discharge planning coordination
- Insurance verification
- Utilization review
- Medicare
- Compliance procedures
Accomplishments
- 2020 PRIIDE Award Nominee
Certification
- Certified Legal Nurse Consultant 2017
Timeline
Director of Utilization Review
UC Health
09.2018 - Current
Denial Prevention Coordinator
Bottom Line Systems Revecore
03.2014 - 09.2018
Bachelor of Science - Nursing
Cleveland State University
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