TONYA COLLINS
Findlay,USA
Summary
Registered Nurse with comprehensive experience in both clinical and insurance-based healthcare settings. Skilled in clinical submissions for medical necessity inpatient admission reviews, prior authorizations, retrospective and Appeal reviews utilizing InterQual and MCG criteria. Experienced in collaborating with care team to support discharge planning and coordinating member needs. Strong background in direct patient care, including assessment, medication administration, patient education, and development of individualized care plans. Dedicated to ensuring high-quality, patient-centered care and efficient healthcare utilization.
Overview
27
27
years of professional experience
Work History
Med Review
American Health Holding
New Albany, Ohio
01.2026 - Current
- Pre-determination/Retrospective reviews and Appeals completed using client specific criteria.
- Proficient in utilizing MCG guidelines and client specific Plan Language.
- Knowledgeable in iSuite and Aetna’s Clinical Policy Bulletins.
Utilization Management
Contigo Health
Hudson, OH
01.2021 - 12.2025
- Utilized clinical skills and criteria to coordinate services for hospitalized patients in acute, skilled long-term care, and outpatient settings, enhancing patient care continuity.
- Collaborate with physician/Medical Director, case management, hospital, and UM team to facilitate and coordinate care needs.
- Perform prospective, concurrent, and retrospective reviews following established guidelines.
- Collaborated with physicians, Medical Director, case management, and UM team to coordinate care needs, ensuring alignment with treatment goals and patient safety.
Utilization Review Nurse
Blanchard Valley Health System
Findlay, Ohio
05.2013 - 01.2021
- Conducted concurrent and retrospective hospital reviews per InterQual criteria, collaborating with case management, social work, and the Medical Director to coordinate patient care needs.
- Reviewed patient records to ensure appropriate levels of care and resource utilization.
Home Health Nurse
Bridge Hospice & Home Health
Findlay, OH
09.2004 - 12.2018
- Delivered in-home care, including disease process education, medication teaching, IV therapy, wound care, and specimen collection.
- Developed personalized care plans in collaboration with patients and families.
Emergency Room Registered Nurse
Blanchard Valley Hospital
Findlay, OH
05.2002 - 09.2004
- Delivered emergency and minor care services to patients of all ages.
Intensive Care Unit Clinical Nurse
Blanchard Valley Hospital
Findlay, OH
05.2001 - 05.2002
- Provided care for critically ill and recovering surgical patients on ventilators and with invasive lines.
Pediatric Registered Nurse
Blanchard Valley Hospital
Findlay, OH
10.1999 - 05.2001
- Cared for pediatric patients and managed Med/Surg overflow.
Education
Associate Degree - Nursing
Owens Community College
Skills
- Critical thinking
- Time management
- Adaptability
- Communication
- Teamwork
Timeline
Med Review
American Health Holding
01.2026 - Current
Utilization Management
Contigo Health
01.2021 - 12.2025
Utilization Review Nurse
Blanchard Valley Health System
05.2013 - 01.2021
Home Health Nurse
Bridge Hospice & Home Health
09.2004 - 12.2018
Emergency Room Registered Nurse
Blanchard Valley Hospital
05.2002 - 09.2004
Intensive Care Unit Clinical Nurse
Blanchard Valley Hospital
05.2001 - 05.2002
Pediatric Registered Nurse
Blanchard Valley Hospital
10.1999 - 05.2001
Associate Degree - Nursing
Owens Community College