Tammy Newman

· Utilization Management Care Coordinator RN 2015 - current

· 10 years of experience as care coordinator, performing medical necessity reviews for procedures / surgeries / medications / treatments / inpatient vs observation level of care

· Maintain production goals with very little direct supervision, as a work from home employee

· Collaborate with team members and other departments as needed to complete tasks

· Collaborate with team members and leaders on process improvement ideas

· Communicate directly with providers on a daily basis

· Experienced using medical policies, Milliman Care Guidelines, contractual language and benefits to determine medical necessity. .

· Well versed in Microsoft Word, PowerPoint, Excel, WebEx, Microsoft Teams, Aerial and SmartUM platforms, MCG, EPIC EMR

· Shown adaptability to change through many process changes, company re-organizations, etc.

· Trained multiple new employees and created training resources as back up Team Lead

· Registered Nurse 1994-2015

· 4 years of experience in acute medical/surgical nursing

· 1 year in surgery

· 4 years NICU

· 11 Maternal/Child Case Manager (including NICU/PICU/Pediatrics/Women's Surgery/Newborn Nursery/Labor & Delivery, Postpartum Care/Special Care Nursey

· Computer skilled, managing multiple patients per shift. Proficient in EMR documentation/record maintenance/paperwork to ensure accuracy and patient confidentiality

· Charge RN on medical/surgical floor

· Work closely with PT/OT/SLP/Social Work for the better outcomes for all Maternal/Child patients.

· Coordinated discharged needs such as Home Heath Care, DME, follow up appointments.

· Responsible for updating insurance companies in regards to patients hospital stay.

· Responsible for managing RSV clinic in hospital setting.