Summary
Overview
Work History
Education
Skills
Certification
Accomplishments
Timeline
Generic

Tasha Critchfield

Kernersville,NC

Summary

Experienced registered nurse with a strong background in utilization management. Passionate about healthcare compliance, policy development, and strategic resource optimization. Experience in cross-functional collaboration and am continuously working on enhancing leadership skills. Skilled at identifying improvement opportunities and translating strategies into actionable plans to drive efficiency, compliance, and improved healthcare outcomes. Known for promoting and fostering a culture of continuous improvement to deliver high-quality care while aligning with business strategic goals.

Overview

21
21
years of professional experience
1
1
Certification

Work History

UTILIZATION MANAGEMENT NURSE (Medicare/Medicaid)

Humana
11.2022 - Current
  • Conduct utilization reviews to assess treatment appropriateness and optimize healthcare resource allocation.
  • Ensure all review processes comply with federal, state, and internal regulations.
  • Lead training for new staff.
  • Contributed to team success by consistently meeting productivity goals while maintaining high-quality standards in job performance.
  • Facilitated workgroup meetings with personnel to find effective solutions to issues.
  • Evaluated diverse organizational systems to identify workflow, communication, and resource utilization issues.
  • Conducted reviews of operations to devise and deploy improvement strategies. Teamed with leaders on implementing improvement initiatives.

TELEPHONIC CARE MANAGER NURSE

Humana at Home, Medicare
06.2017 - 06.2020
  • Coordinated care for patients with chronic conditions, focusing on effective resource utilization and comprehensive care planning.
  • Educated patients and their families on benefits programs, self-care strategies, and available healthcare resources.
  • Collaborated with healthcare providers and social workers to ensure seamless care coordination and effectively address any gaps in care.
  • Monitored patient progress and adjusted care plans to align with evolving healthcare needs and optimize outcomes.

CASE MANAGER

Hospice and Palliative Care Center
06.2015 - 06.2017
  • Managed home care cases by coordinating with multidisciplinary teams to ensure seamless patient care.
  • Developed and adjusted individualized care plans to meet patient needs, adhering to current healthcare standards.
  • Conducted regular evaluations of case management processes, recommending and implementing improvements as needed.
  • Collaborated with patients and families to create personalized care plans and connect them with appropriate community resources.

INTERVENTIONAL RADIOLOGY CHARGE NURSE

Atrium Health Wake Forest Baptist Medical Center
03.2013 - 05.2015
  • Led a team of radiology nurses, overseeing patient care in all radiology areas, including CT, MRI, Nuclear Medicine, and Interventional Radiology (IR).
  • Monitored patients for adverse reactions during interventional procedures and ensured proper sterilization of equipment and cleanliness of exam rooms.
  • Assisted in various radiology procedures, such as biopsies, drainages, and catheter insertions, while providing post-procedure care guidance to patients.
  • Trained new radiology nurses on departmental protocols, ensuring adherence to safety standards and best practices while maintaining current knowledge through continuing education courses.

EMERGENCY DEPARTMENT NURSE/Sexual Assault Nurse Examiner

Atrium Health Wake Forest Baptist Medical Center
03.2009 - 03.2013
  • Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
  • Streamlined emergency room operations by efficiently triaging patients according to the severity of their condition.
  • Collaborated with multidisciplinary teams to provide comprehensive support for sexual assault survivors, addressing their physical, emotional, and legal needs.
  • Collaborated with law enforcement and district attorneys to improve services for sexual assault victims.

EMERGENCY DEPARTMENT NURSE

Dartmouth-Hitchcock Medical Center
01.2007 - 02.2009
  • Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
  • Assisted physicians during invasive procedures such as central line insertions or intubations, ensuring safe and accurate completion of tasks.
  • Streamlined emergency room operations by efficiently triaging patients according to severity of condition.

MEDICAL SURGICAL NURSE

New London Hospital
06.2003 - 01.2007
  • Demonstrated excellent critical thinking skills during emergent situations, collaborating with team members to deliver timely interventions and stabilize patients.
  • Monitored patients before, during and after surgical operations to evaluate patient care.
  • Provided high level of individualized care to adult patients across multiple medical specialties.
  • Educated patients and families on medical-surgical procedures, therapeutic regimens, and pain management techniques.

Education

Master of Science - MSN: Nursing Informatics

Western Governors University
Salt Lake City, UT
01.2026

Bachelor of Science - Nursing

Pima Medical Institute
Tucson, AZ
01.2024

Associate of Science - Nursing

River Valley Community College
Claremont, NH
01.2003

Skills

  • Utilization Management Strategy
  • Healthcare Compliance
  • Policy Development
  • Cross-Functional Collaboration
  • Process Improvement
  • Leadership & Team Management
  • Regulatory Compliance
  • Medical Necessity Evaluation
  • Milliman Guidelines
  • Training & Development
  • Cost-Effective Solutions
  • Quality Assurance
  • Healthcare Resource Management
  • Patient Care Coordination
  • Documentation & Record-Keeping
  • Medicaid/Medicare Knowledge

Certification

  • Registered Nurse (RN), North Carolina, #230043, 03/13/2009 to 04/30/2026
  • Registered Nurse (RN), District of Columbia, #200005786, 09/19/2022 to 06/30/2024
  • MCG Care Guidelines Specialist Certification, MCG: Part of the Hearst Health Net., 06/2024 to 06/2026
  • Sexual Assault Nurse Examiner (SANE), Wake Forest Baptist Medical Center, 2014
  • Trauma Nurse Core Course (TNCC), Emergency Nurses Association, 2015-2019
  • Emergency Nursing Pediatric Course (ENPC), Emergency Nurses Association, 2015-2019
  • Advanced Cardiac & Pediatric Life Support (ACLS)/(PALS), American Heart Association, 2015-2017

Accomplishments

  • Leadership Development: Completed Humana's six-month Clinician Leadership Experience development program (05/2023–11/2024), which included leadership training, mentorship, and a capstone presentation showcasing a commitment to professional growth and leadership skills.
  • Process Improvement and Compliance: Collaborated with departmental workgroups to test and assess integrated faxing capabilities.
  • Process Improvement and Compliance: Collaborated with organizational workgroups in the development and implementation of NLP (natural language processing) workflow.
  • Process Improvement and Compliance: Obtained an MCG Care Guidelines Specialist Certification.


Timeline

UTILIZATION MANAGEMENT NURSE (Medicare/Medicaid)

Humana
11.2022 - Current

TELEPHONIC CARE MANAGER NURSE

Humana at Home, Medicare
06.2017 - 06.2020

CASE MANAGER

Hospice and Palliative Care Center
06.2015 - 06.2017

INTERVENTIONAL RADIOLOGY CHARGE NURSE

Atrium Health Wake Forest Baptist Medical Center
03.2013 - 05.2015

EMERGENCY DEPARTMENT NURSE/Sexual Assault Nurse Examiner

Atrium Health Wake Forest Baptist Medical Center
03.2009 - 03.2013

EMERGENCY DEPARTMENT NURSE

Dartmouth-Hitchcock Medical Center
01.2007 - 02.2009

MEDICAL SURGICAL NURSE

New London Hospital
06.2003 - 01.2007

Master of Science - MSN: Nursing Informatics

Western Governors University

Bachelor of Science - Nursing

Pima Medical Institute

Associate of Science - Nursing

River Valley Community College

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Tasha Critchfield