Stephanie Williamson
West Monroe,LA
Summary
Accomplished Case Management Utilization Review Nurse with a proven track record at Glenwood Regional Medical Center, enhancing client care and ensuring regulatory compliance. Expert in utilization review and fostering team collaboration, significantly minimized financial risks and improved care quality. Skilled in policy compliance and readmission reduction, demonstrating exceptional leadership and problem-solving abilities.
Overview
29
29
years of professional experience
Work History
Case Management Utilization Review Nurse
Glenwood Regional Medical Center
06.2018 - Current
- Collaborated with multidisciplinary teams to facilitate client care and reduce case management barriers.
- Collaborated with senior leadership to develop strategic plans for future growth, addressing key challenges facing the organization while capitalizing on existing strengths.
- Served as corporate resource for compliance and audits to facilitate insurance approvals and assistance with appeals.
- Ensured compliance with regulatory requirements through consistent monitoring for adherence to established policies and procedures as well as state and federal guidelines.
- Minimized financial risk associated with denials or payment discrepancies through diligent validation of medical necessity prior to service provision.
- Completed bi-weekly payroll for 14 employees.
- Promoted a culture of continuous learning by conducting regular staff meetings focused on team collaboration.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
Registered Nurse
Glenwood Home Health
11.2015 - 12.2017
- Worked with multidisciplinary team to carry out successful treatment plans for diverse acute and chronic conditions.
- Assessed patients' health status and developed individualized care plans to suit needs.
- Managed patient medical records accurately and confidentially, ensuring compliance with HIPAA regulations.
- Delivered high level of quality care to diverse populations while overseeing patient admission, recertification and discharge
- Led teams in driving successful patient outcomes by prioritizing standard of care and best practices.
Case Management Specialist
United Home Care
05.2012 - 11.2015
- Ensured regulatory compliance by regularly monitoring adherence to federal, state, and agency guidelines in all aspects of home health nursing practice.
- Collaborated with upper management to establish performance goals for the team and develop strategies for achieving them.
- Maintained accurate records and documentation, ensuring compliance with regulatory requirements and facilitating seamless audits.
- Led weekly meetings with staff to discuss progress updates, address concerns, and maintain open lines of communication.
- Managed performance reviews for 8 employees, analyzing individual employee achievements and overall trends in workforce execution metrics.
Registered Nurse
St Francis Medical Center
12.1995 - 04.2012
- 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.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Managed caseload of 5-7 patients simultaneously by providing bedside care, treatments, IV therapy, and wound care.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
Education
Associate of Science - Nursing
Excelsior College
Albany, NY07-2014
Skills
- Utilization review
- Healthcare regulations
- Clinical quality incentives
- Bundled payments
- InterQual admissions criteria
- Case Management
- Policy compliance
- Readmission reduction
Timeline
Case Management Utilization Review Nurse
Glenwood Regional Medical Center
06.2018 - Current
Registered Nurse
Glenwood Home Health
11.2015 - 12.2017
Case Management Specialist
United Home Care
05.2012 - 11.2015
Registered Nurse
St Francis Medical Center
12.1995 - 04.2012
Associate of Science - Nursing
Excelsior College
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