Shauna J Cook
Summary
Experienced leader with strong background in guiding teams, managing complex projects, and achieving strategic objectives. Excels in developing efficient processes, ensuring high standards, and aligning efforts with organizational goals. Known for collaborative approach and commitment to excellence.
Overview
24
24
years of professional experience
1
1
Certification
Work History
UM Clinical Reviewer Senior Analyst
EviCore by Evernorth
01.2016 - Current
- Clinical review using established guidelines to determine medical necessity for multiple CPT codes/health plans/lines of business
- Work collaboration with entire department including Genetic Counselors and Medical Directors to ensure timely processing of cases.
- Work alongside multiple other team members in different departments including a liaison with claims supervisor prior to process change.
- Trainer to multiple new employees, mentor current employees in need of additional assistance/or education.
- Assisted with the update of CR training materials for new hires
- Revision of SOP's to include nurse processes and updated each year to ensure accuracy
- Review of CEG with lab variations documented
- Assisted with writing quarterly IRR
- Entered Policies into PRPs for new policy periods.
- Member of the Party Planning Committee (PPC).
- Assist team members daily with case processing and questions, assisting with learning how to find the answers to questions in SmartSheet.
UM Nurse Consultant
Aetna
05.2012 - 09.2015
- Completed clinical reviews of prior authorization requests.
- Reviewed clinical information/medical records to determine medical necessity of requested services.
- Worked collaboratively with other team members, Medical Directors and providers requesting services.
- Achieved average of 98% on monthly quality audit. Completed daily work load as assigned. (Worked from home in Utah).
Long Term Care Medically Complex Nurse Supervisor
Aetna
01.2011 - 05.2012
- Supervised, directed, and motivated high-quality performance from nursing staff.
- Conducted audits of all nurses monthly
- Assisted nurses with difficult cases/situations through collaboration with families/members, and made home visits with nurses when needed
- Collaborated with non-clinical case managers to assist with managing difficult members to determine need for transfer to higher level of management.
- Participated in weekly grand rounds to review complex issues/cases working with Medical Directors, Supervisors, Pharmacists, etc.
- Worked with other departments to ensure completion of needed services.
- Completed monthly one on one meetings with staff to discuss issues/concerns/progress along with mid-year and end of year evaluations.
- Upheld high standards of nursing practice through continuous education on current trends, emerging challenges in healthcare delivery systems.
- Trained, evaluated and coached staff to improve performance.
- Collaborated with interdisciplinary teams to develop comprehensive treatment plans for complex patients, resulting in better health outcomes.
Prior Authorization Nurse Supervisor
Aetna
07.2007 - 01.2011
- Supervisor of all prior authorization nurses along with non-clinical staff in the prior authorization department.
- Completed monthly audits, daily schedules for phone queue staff and fax clinical reviews of authorization requests, completed daily work assignments for staff,
- Monitored employee metrics and monitored compliance to ensure efficiency
- Planned and completed monthly staff meetings.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Completed multiple special assignments as requested by manager and was part of team planning for training, continuing education and yearly testing when needed.
- Completed hiring and firing of employees as necessary.
- Completed monthly one on one meetings with staff to discuss issues/concerns/progress along with mid-year and end of year evaluations.
- Demonstrated commitment to professional development by participating in ongoing training opportunities related to the field of Prior Authorization nursing.
- Participated in interdisciplinary team meetings, collaborating with other healthcare professionals to ensure seamless coordination of care for patients requiring prior authorizations.
Clinical Manager
Banner Desert Medical Center
11.2001 - 07.2007
- Registered nurse and Clinical Manager of a 30 bed high risk OB/Antepartum unit.
- Assisted with monthly schedules and daily staffing
- Performed biweekly payroll, completed yearly evaluations
- Oversaw overall operation of nursing services and patient care.
- Communicated effectively with staff members, physicians, and patients, employing active listening and interpersonal skills.
- Regularly evaluated employee performance and provided feedback.
- Enhanced staff performance through regular training, mentoring, and professional development opportunities.
Education
Bachelors Degree - Nursing
Idaho State University
Pocatello, Idaho05.1993
Skills
- Teamwork and collaboration
- Time management
- Organizational skills
- Attention to detail
- Excellent communication
- Detail-oriented
- Task prioritization
- Self motivation
- Customer service
Certification
Registered Nurse: Utah (Compact Licensure) expires Jan 2027
Timeline
UM Clinical Reviewer Senior Analyst
EviCore by Evernorth
01.2016 - Current
UM Nurse Consultant
Aetna
05.2012 - 09.2015
Long Term Care Medically Complex Nurse Supervisor
Aetna
01.2011 - 05.2012
Prior Authorization Nurse Supervisor
Aetna
07.2007 - 01.2011
Clinical Manager
Banner Desert Medical Center
11.2001 - 07.2007
Bachelors Degree - Nursing
Idaho State University
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