Summary
Overview
Work History
Education
Skills
Additional Experience
References
Timeline
Generic

Staci Dickens

Westmoreland,TN

Summary

Dedicated registered nurse with hands-on nursing, utilization review, and case management experience across a variety of healthcare environments. Successful in evaluating the appropriateness and medical necessity of treatments, services, and facilities. Aspiring to leverage a broad spectrum of knowledge and extensive field experience to secure a PRN case management position with a focus on delivering comprehensive assessment, facilitation, care coordination, and advocacy to meet high quality, patient centered care needs. Recognized ability to communicate with patients and providers, train and manage staff, resolve complex medical problems, and encourage teamwork to provide clinically competent care and cost effective outcomes.

Overview

12
12
years of professional experience

Work History

RN UM Reviewer

Anthem Oil & Gas
Nashville, TN
07.2019 - Current
  • Coordinate member care transitions with a healthcare continuum while referring treatment plans to clinical reviewers. Conduct precertification, continued stay review, care coordination, and discharge planning to evaluate the appropriateness of treatment settings in compliance with utilization review criteria, medical policy, member benefits, and contracts. Lead all members, programs, and community resources while providing strategic consultation to providers. Facilitate accreditation by applying regulatory requirements and service standards. Assess members' needs for early identification by communicating with providers.
  • Promoted to senior nurse due to excellent nursing service and care.
  • Optimized members' outcomes and benefits, interpreted all levels of care and claim payment, and promoted the utilization of resources by collaborating with medical directors, healthcare providers, and members.
  • Maintained the appropriate level of care throughout the medical management process by consulting with clinical reviewers and medical directors, assessing the needs of inpatient admissions, outpatient, and out-of-network services, surgical and diagnostic procedures, and interpreting benefits and managed care products.
  • Assured member access to medical necessity and quality healthcare as per the contract.

Case Manager, Utilization Review Nurse

Sumner Regional Medical Center
Gallatin, TN
11.2015 - 07.2019
  • Delivered wide-ranging case management, utilization review, and nursing support to diverse patient populations, such as geriatrics, adults, adolescents, and pediatrics. Carried out prior authorization and concurrent reviews to determine medical necessity in the inpatient setting using medical and internal guidelines; submitted authorization to payors to ensure proper payment. Reviewed medical records for accurate documentation while understanding Medicare, managed care, and commercial insurance processes.
  • Reduced readmissions and met post-acute care needs by coordinating community care and services, including care cases.
  • Ensured direct discharge planning and supported patient transfers by working with the medical director.

MDS Coordinator - Care Management

Westmoreland Care And Rehab
Westmoreland, TN
01.2015 - 11.2015
  • Assessed, executed, and coordinated all levels of care and determination regarding coverage and services to achieve expected goals by collaborating with all disciplines. Coordinated the development of QA processes, such as performance improvement plans.
  • Completed medical record and MDS assessments by implementing CMS regulations for accuracy.
  • Ensured accuracy and completion through the implementation of interdepartmental and facility audits.

Skilled Assessment Admissions Nurse, ADON

Mt Juliet Healthcare/Vanco Manor (THM Companies)
Goodlettsville, TN
05.2014 - 01.2015
  • Provided motivational and disease management coaching to both residents and employees to support health and wellness. Coordinated active nursing care with admission, recovery, and discharge of patients.
  • Worked direclty with DON to ensure quality patient care including discharges from rehab with appropriate resources into the community

Weekend Nursing Supervisor

Cumberland Heights Treatment Center
Nashville, TN
06.2012 - 05.2014
  • Determined appropriateness for admission and assessed on-time patient triage at the highest level of care by executing triage assessments, including medical history, physical, psychological, and environmental.
  • Led a multi-disciplinary team's efforts to deliver comprehensive care and motivational teaching to clients.
  • Coordinated appropriate community care and followed up upon discharge.

Education

Associate of Applied Science - Nursing

Tennessee State University
Nashville
05-1999

Skills

  • Skilled RN; Critical Care and Clinical Support
  • Admission & Discharge/ Treatment Planning
  • Case Management; Utilization Review
  • Medical Necessity & Triage Assessment
  • Critical Thinking/ Personalized Interventions
  • Compassionate Patient & Community Care
  • Medical History Recording & Documentation
  • Conflict Resolution, Collaborative Communication

Additional Experience

  • MDS Coordinator/Care Management / Gallatin Healthcare, 2008-2012
  • Labor and Delivery/Postpartum and Nursery Nurse / Sumner Regional Medical Center and Centennial Medical Center, 1999-2007

References

  • Jodi Bertram 765-591-5129
  • Pat Rich 270-237-0238
  • MaryLou Sankovich 330-545-4200

Timeline

RN UM Reviewer

Anthem Oil & Gas
07.2019 - Current

Case Manager, Utilization Review Nurse

Sumner Regional Medical Center
11.2015 - 07.2019

MDS Coordinator - Care Management

Westmoreland Care And Rehab
01.2015 - 11.2015

Skilled Assessment Admissions Nurse, ADON

Mt Juliet Healthcare/Vanco Manor (THM Companies)
05.2014 - 01.2015

Weekend Nursing Supervisor

Cumberland Heights Treatment Center
06.2012 - 05.2014

Associate of Applied Science - Nursing

Tennessee State University

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Staci Dickens