Stacy Thomas
Grosse Pointe Woods,MI
Summary
Accomplished Utilization Review Nurse with a proven track record at Henry Ford Health St John (Ascension), adept in documentation and reporting, and fostering continuous learning. Excelled in enhancing team capabilities and ensuring regulatory compliance, demonstrating exceptional case management and interpersonal skills.
Overview
22
22
years of professional experience
Work History
Utilization Review Nurse
Henry Ford Health St John (Ascension )
12.2020 - Current
- Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
- Performed prior authorization review of services requiring notification.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Fostered a culture of continuous learning by actively participating in departmental meetings, trainings, and continuing education opportunities related to utilization review.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Performed admission reviews based for medical necessity..
- Conducted training sessions for new nurses, enhancing team's review capabilities.
- Manage Denials list, analyzing denial for either downgrade in level of care or escalating case for appeal.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
Case Manager
Ascension St John Hospital
08.2016 - 12.2020
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
- Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
- Advocated for client rights when interacting with external agencies or institutions, ensuring fair treatment at all times.
- Coordinated essential services for clients, resulting in improved overall well-being and selfsufficiency.
- Partnered with physicians, social workers, activity therapists, nutritionists, and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems.
- Promoted a safe environment for vulnerable populations by reporting suspected abuse or neglect.
- Performed basic Utilization review on inpatient admissions.
Registered Nurse
Beaumont Grosse Pointe
05.2013 - 06.2018
- Maintained competency in diverse clinical settings by regularly floating between units, adapting quickly to unique patient populations and environments.
- Prevented complications through early identification of potential issues and prompt intervention when necessary.
- Served as a resource for medical professionals across various departments, fostering effective communication and collaboration among healthcare providers.
- Administered medications and treatments as prescribed by physicians.
- Preserved confidentiality by adhering to HIPAA regulations while managing sensitive patient information in both written and verbal communications.
Registered Nurse
Ascension St John Hospital
05.2005 - 08.2016
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Enhanced patient satisfaction by providing compassionate, holistic nursing care that addressed physical, emotional, and spiritual needs.
- Assisted in the training and mentorship of new nursing staff members, contributing to a positive work environment and high-quality patient care.
- Prevented the spread of infections by consistently adhering to strict infection control protocols and educating patients on proper hygiene practices.
- Collaborated with interdisciplinary teams to develop comprehensive treatment plans for complex patients with multiple comorbidities.
- Served as a preceptor for nursing students during their clinical rotations, providing valuable real-world experience and guidance to foster professional growth.
- Provided support for patients'' families during difficult medical decisions or end-of-life care, serving as a liaison between the healthcare team and loved ones.
- Promoted a culture of safety within the healthcare facility by participating in quality improvement initiatives, identifying potential hazards, and advocating for best practices in nursing care delivery.
Registration Clerk
Ascension St John Hospital
02.2003 - 05.2005
- Completed registration paperwork, verifying accurate patient information.
- Answered patient questions and inquiries regarding registration process and documentation.
- Provided training to new registration clerks on policies, procedures, and best practices for maintaining an efficient workflow within the department.
- Managed high call volumes while accurately scheduling appointments and directing calls to appropriate departments as needed.
- Entered patient information into payment system accurately for billing purposes.
- Served as a liaison between patients, clinical staff, and administrative personnel to facilitate optimal communication and coordination of care.
- Updated patient contact information to support accurate electronic medical records.
Education
Bachelor of Science - Nursing
University of Detroit Mercy
Detroit, MI12-2020
Associate of Applied Science - Nursing
Henry Ford College
Dearborn, MI05-2005
High School Diploma -
Wayne Memorial High School
Wayne, MI06-1992
Timeline
Utilization Review Nurse
Henry Ford Health St John (Ascension )
12.2020 - Current
Case Manager
Ascension St John Hospital
08.2016 - 12.2020
Registered Nurse
Beaumont Grosse Pointe
05.2013 - 06.2018
Registered Nurse
Ascension St John Hospital
05.2005 - 08.2016
Registration Clerk
Ascension St John Hospital
02.2003 - 05.2005
Bachelor of Science - Nursing
University of Detroit Mercy
Associate of Applied Science - Nursing
Henry Ford College
High School Diploma -
Wayne Memorial High School
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