Open To Work
Tammi Grundhoefer
Hudson,WI
Summary
Dynamic healthcare professional with a proven track record in team collaboration and exceptional results. Adept at providing comprehensive care management to ensure optimal patient outcomes while demonstrating adaptability to evolving healthcare needs. Offers reliable support through skilled patient advocacy, efficient care coordination, and strategic resource management. Committed to a compassionate approach that fosters trust and respect, enhancing the patient experience and driving quality care initiatives.
Overview
11
11
years of professional experience
3
3
Certifications
2
2
State RN Licensures
Work History
Utilization Review / Care Manager
Osceola Medical Center
Osceola, WI
09.2025 - Current
- Oversaw comprehensive care coordination and discharge planning to ensure optimal health outcomes and cost-effective health care solutions.
- Coordinated efforts among care teams, including physicians, social workers, and nursing staff, to develop and execute comprehensive treatment and discharge plans for seamless transitions in levels of care.
- Conducted utilization reviews to determine medical necessity and service appropriateness, facilitating optimal healthcare services for patients.
Utilization Management Program Manager
Regions Hospital (HealthPartners)
St Paul, MN
01.2021 - 11.2024
- Managed enterprise utilization management program by coordinating efforts with utilization management operations manager, hospital case management, behavioral health services, and essential internal stakeholders including patient and financial services.
- Facilitated comprehensive management of utilization appeals and denials, collaborating with key stakeholders to uphold compliance and operational integrity.
- Achieved enhanced program management through comprehensive oversight of utilization management quality assurance program. Delivered detailed departmental audits and individualized staff reports to inform decision-making. Improved process efficiency by analyzing productivity measures on a regular basis.
- Developed and executed comprehensive education strategies for utilization management, ensuring all employees received necessary training for compliance with policies and regulations.
- Coordinated efforts with medical staff and other departments to optimize utilization management strategies, ensuring compliance with government, commercial, and regulatory requirements.
Utilization Management RN Reviewer / Team Lead
Regions Hospital (HealthPartners)
St. Paul, MN
07.2015 - 01.2021
- Facilitated effective management of enterprise utilization program to enhance patient care and optimize financial services.
- Implemented comprehensive training initiatives for new and existing utilization management staff to ensure compliance with organizational and regulatory standards.
- Oversaw implementation and compliance of utilization management protocols by performing routine evaluations of staff performance.
- Evaluated appropriateness and efficiency of specific services within the organization to ensure patients receive appropriate healthcare services and benefits.
- Orchestrated comprehensive care delivery strategies to ensure effective and cost-efficient health care for patients.
Education
Bachelor of Science - Nursing
Capella University
Minneapolis, MN03.2020
Associates of Science - Nursing
Century College
White Bear Lake05.2008
Bachelor of Science - Education
St. Cloud State University
St. Cloud, MN05.2001
Skills
- Care Coordination
- Care Management
- Discharge Planning
- Patient Outcomes
- HealthCare Management
- Interdisciplinary Collaboration
- Resource Allocation
- Patient Advocacy
- Crisis Intervention
- Medicaid Medicare Managed Care
- Utilization Management
- Appeals Denials
- Medical Necessity
- Prior Authorization
- Inpatient Outpatient
- InterQual guidelines MCG guidelines
- EPIC systems
- XSOLIS platform
Certification
- Minnesota Board of Nursing License #: R 187808-2
- Wisconsin Board of Nursing License #: 167292
- InterQual Certified Reviewer
- MCG Certified Care Guidelines Specialist
Work Preference
Work Type
Full TimeLocation Preference
RemoteTimeline
Utilization Review / Care Manager
Osceola Medical Center
09.2025 - Current
Utilization Management Program Manager
Regions Hospital (HealthPartners)
01.2021 - 11.2024
Utilization Management RN Reviewer / Team Lead
Regions Hospital (HealthPartners)
07.2015 - 01.2021
Bachelor of Science - Nursing
Capella University
Associates of Science - Nursing
Century College
Bachelor of Science - Education
St. Cloud State University