THERESA HUDSON BSN, RN, CPC

Work History

Clinical Lead Nurse

AmeriHealth Caritas Family Of Companies

02.2015 - Current

The Clinical Lead is a mid-management role responsible for executing plans, development, and implementation of policies, procedures, and SOPs which impact over 750 UM front-line staff.
Recognized expert within UM; contributes to execution of strategic partnerships and projects, both internal/external within New Markets including Medicaid, Medicare, and Exchange products.
Leads UM initiatives, delivery, management, and facilitation of operations to meet regulatory and beneficiary expectations.
Analyze and identify risk areas to determine compliance with contractual requirements, State, Federal, and NCQA regulations as they relate to UM policies, procedures, and workflows.
Apply official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to recommend prior authorization rules, interpret benefits coverage, and identify coding trends and discrepancies.
Create, develop, and implement cost-saving strategies to improve productivity, improved communication, and better time management.

RN Supervisor

The Health Center Of Galloway

01.2024 - Current

Improve patient outcomes by implementing evidence-based nursing practices and protocols.
Manage staffing schedules, ensuring adequate coverage for all shifts while minimizing overtime costs.
Collaborate with interdisciplinary teams to develop comprehensive care plans tailored to individual patient needs.
Serve as a liaison between administration, medical staff, and nursing team for seamless communication and coordination of care efforts.
Enhance staff performance through regular coaching, training, and performance evaluations.
Develop, maintain, and update written policies and procedures.
Develop, maintain, and implement facility's quality assurance program.
Participate in facility surveys made by authorized government agencies.
Monitor stock level of medications, medical supplies, and equipment.

Nurse Instructor

Prism Career Institute

08.2018 - 01.2024

Monitor progress of each student and provide formal evaluation upon completion of clinical placements.
Coach underperforming students to help meet clinical objectives.
Directly care for patients at least 32 hours each month to maintain currency on clinical techniques.
Oversee laboratory and clinical environments to help students advance knowledge and abilities.
Assess student knowledge levels and abilities with detailed assessments.
Developed and create clinical assignments to assess student skills.
Compiled, administered and graded examinations to evaluate and record student comprehension levels.

Prior Authorization Analyst

AmeriHealth Caritas Family Of Companies

03.2019 - 11.2021

Increased efficiency by streamlining data analysis processes and implementing automation tools.
Identified trends and patterns in large CPT/HCPC datasets, leading to actionable insights for business growth.
Enhanced team collaboration by providing clear communication of complex findings through visualizations and reports.
Optimized resource allocation by conducting thorough cost-benefit analyses as it relates to utilization of services/items on a CPT/HCPC coding level.
Able to navigate in Facets and Appian platforms with ease.

Medical Loss Unit Nurse

AmeriHealth Caritas Family Of Companies

02.2017 - 03.2019

Performed high-level clinical reviews on Hospital Acquired Conditions using established evidence-based guidelines which resulted in identification of conditions not present on admission that are high cost resulting in cost containment strategies and retraction of high-dollar claims.
Completed quarterly reviews on sentinel, near events, and adverse events on State level.
Performed State reviews on claims identified as overpayments.
Provide billing analysis of claims and applying standards of federal regulations to ensure correct billing practices.
Evaluate medical insurance claims by verifying patient information, reviewing medical records, determining coverage benefits coding claims accurately, and communicating with internal management solutions to resolve issues causing claim denial for the provider.

Prior Authorization Nurse

AmeriHealth Caritas Family Of Companies

02.2015 - 02.2017

Streamlined the prior authorization process, reducing wait times and improving overall efficiency.
Collaborated with healthcare providers to ensure accurate submission of required documentation for timely authorizations.
Assisted in maintaining compliance with changing NCQA and State regulations and policies by staying up-to-date on industry trends and best practices.
Follow all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
Worked closely with case managers to facilitate appropriate utilization of healthcare resources through the prior authorization process.
Mentored new hires within the team, sharing expertise in navigating complex insurance guidelines and best practices for managing workflow efficiently.

Vaccine Nurse

South Jersey Family Medical Center

07.2021 - 02.2022

Safely administered 1st and 2nd COVID vaccinations, providing education to patients on vaccines, dosage, indications, precautions, contraindications and potential side effects.
Monitor patient reactions during administration of injections.
Implemented and adhered to infection-control policies and procedures.
Contributed to promoting the COVID vaccine.
Worked with individuals to determine specific needs based on fears, rumors, and misinformation related to COVID vaccines.

Urgent Care Registered Nurse

Atlanticare Regional Medical Center

05.2017 - 09.2018

Conducted telephone triage to patient, family and significant others using nursing judgment according to protocol.
Executed nursing interventions by collaborating with interprofessional team to incorporate standards of care, practice and patient outcomes.
Managed patients with multiple chronic health conditions, acute episodes of care and behavioral health challenges while promoting and supporting prevention and wellness.
Participated in staff meetings and brain-storming sessions related to Press Ganey patient experience results.

Nurse Supervisor

Ches Penn Health Services

03.2013 - 02.2015

Supervised, directed, and motivated high-quality performance from clinical staff.
Increased documentation skills of MA staff to meet CMS requirements directly tied to HEDIS measurements and reimbursement of medical costs to patient outcomes.
Designated VFC coordinator responsible for providing oversight for all vaccine management within office and ensuring all vaccines were stored and handled correct.
Implemented effective patient education techniques to improve health outcomes.
Assisted with caring for specific patient populations by utilizing excellent clinical skills and judgment.
Maintained medical and pharmacy budget to maintain effective inventory levels.
Implemented strategies to increase prior authorization approval and decrease unnecessary denials for 30 doctors and residents related to medications, diabetic supplies, and advanced imaging.

Home Health Nurse

Crozer-Keystone

04.2012 - 05.2015

Provided physical assessments, medication, and chronic disease management to home health patients.
Educated patients and families on disease processes, medications and treatments.
Administered medications and treatments as prescribed by physicians.
Monitored vital signs, developed and implemented care plans, and documented patient progress.
Performed complex wound care including diabetic, pressure ulcers all stages utilizing established evidenced-based care and wound vacs.
Managed pleurax catheters, nephrostomy tubes, JP drains, and blake drains.

Clinical II Nurse, Emergency Department

Childrens Hospital Of Philadelphia

07.2009 - 04.2012

Collaborated with multidisciplinary team to evaluate patient data and determine patient care plans.
Responded to patient emergencies to provide prompt and correct intervention .
Administered medications and treatments to manage patient's condition.
Utilized evidence-based practice to assess and provide care for patients.
Provided basic educational services to parents and guardians on topics such as child growth and development and special needs.

Emergency Medical Technician

Exceptional Medical Transportation

05.2005 - 07.2010

Maintained levelheadedness and efficiency in high-pressure situations, effectively prioritizing tasks to save lives and provide medical care in 911 setting within Atlantic City, New Jersey.
Maintained accurate patient records and documentation of treatments to enable tracking history and safeguard information.
Conducted equipment and vehicle checks to maintain continuous and safe operation.
Evaluated patient vital signs and status to determine care needs using pulse oximeters and electronic vital sign machines.

Emergency Room Nurse Technician

Atlanticare Regional Medical Center

08.2008 - 02.2009

Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
Communicated openly and collaboratively with all healthcare staff to organize successful patient care.
Teamed on trauma and emergency interventions involving serious head injuries, gunshot wounds, and thoracic trauma.
Cared for as many as 12 patients each day, quickly identifying concerns, controlling symptoms and providing expert emergency care.
Upheld infection control and prevention policies across different patient-facing areas.
Followed directions of licensed nurses to administer medications and treatments.

Training Manager

Rainforest Cafe

04.2004 - 05.2006

Enhanced employee performance by designing and implementing comprehensive training programs.
Reduced onboarding time for new hires through the development of effective orientation modules.
Evaluated the effectiveness of training programs using various assessment tools, providing valuable feedback for continuous improvement initiatives.
Alternated training methods to diversify instruction, strengthen learning opportunities, and enhance program success.

General Manager of Food Service

Johnny Rockets Restaurant

01.2001 - 02.2004

Prepared weekly schedules and assigned tasks to staff of 75 to maintain organized shift and smooth operations.
Controlled labor hours and inventory costs through hands-on management and proactive changes.
Addressed and resolved customer service issues to establish trust and increase satisfaction.
Oversaw balancing of cash registers, reconciled transactions, and deposited establishment's earnings to bank.
Trained and supervised new staff with company policies to enhance customer service skills and comply with food safety standards.
Set and enforced performance and service standards to keep consistent, high-quality environment devoted to customer satisfaction.

Table Games Floor Supervisor

Mohegan Sun Casino

11.1996 - 12.2000

Trained employees in procedures, compliance standards and strategies for accomplishing objectives.
Monitored game operations to enforce house rules as well as tribal, state and federal regulations.
Monitored chips purchases, table inventories and player win ratios in blackjack and craps.
Oversaw area games to maintain security and compliance.
Eliminated customer service issues by quickly resolving disputes and correcting problems.
Listened effectively and used issue resolution skills to efficiently handle guest complaints and promote brand loyalty.

Table Games Dual Rate Dealer

Foxwoods Casino And Resort

01.1992 - 05.1995

Trained employees in procedures, compliance standards and strategies for accomplishing objectives.
Monitored game operations to enforce house rules as well as tribal, state and federal regulations.
Monitored chips purchases, table inventories and player win ratios in blackjack and craps.
Oversaw area games to maintain security and compliance.
Eliminated customer service issues by quickly resolving disputes and correcting problems.
Listened effectively and used issue resolution skills to efficiently handle guest complaints and promote brand loyalty.

Summary

Overview

Work History

Clinical Lead Nurse

RN Supervisor

Nurse Instructor

Prior Authorization Analyst

Medical Loss Unit Nurse

Prior Authorization Nurse

Vaccine Nurse

Urgent Care Registered Nurse

Nurse Supervisor

Home Health Nurse

Clinical II Nurse, Emergency Department

Emergency Medical Technician

Emergency Room Nurse Technician

Training Manager

General Manager of Food Service

Table Games Floor Supervisor

Table Games Dual Rate Dealer

Education

Master of Science - MSN Ed

Bachelor of Science : BSN -

Skills

Certification

Timeline

Additional Information

Languages

Leadership

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