Tonya Marr RN

Collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources for the most complex or elevated medical issues.
Provided virtual training to off-shore nursing staff in utilization review and continue to support off-shore staff with clinical expertise as needed.
Participate in weekly grand rounds and NICU grand rounds for case reviews to facilitate communication with the case management team to enable coordination of care for members.
Primary duties may include, but are not limited to: continued stay review, care coordination, and discharge planning for appropriateness of treatment setting.
Ensure medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures and out of network services.
Review appropriateness of treatment setting by utilizing the applicable medical policy and industry standards.
Accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources.
Work with medical directors in interpreting appropriateness of care and accurate claims payment.
Collaborates with providers to assess members needs for early identification of and proactive planning for discharge planning.


Systems used:
AMCP, WMDS, ANITA, VB, Share Point & Knowledge Library

• Collaborated with healthcare leaders and physicians to support and offer resources in performance of duties to maintain high-quality and efficient patient care.
• Educated patients and caregivers on healthcare protocols and processes.
• Developed and modified patient care plans and assisted interdisciplinary team in identifying client needs and goals to determine priorities of care.
• Analyzed patient responses to medications, therapies and variances in plans of care.
• Implemented aspects of patient care under physician orders and sought clarification when needed to promote safety, quality and cost-efficient care.
• Increased referral rates by providing excellent service and building meaningful relationships with patients and caregivers.
• Gathered and recorded patient health information and data to assess, identify and manage characteristics that affect care outcome.
• Developed provider referral program to maintain long-term patient wellness.

• Offered leadership, support and clinical expertise within care management teams to achieve outcomes.
• Educated and evaluated clinical and support staff regarding care quality management regulations and standards of care.
• Facilitated assessment of individual physiological, psychological, financial, cultural and family situation and coordinated social services to address individual and family needs.
• Coordinated and analyzed sustainable person-centered care plans involving internal and external providers.
• Concurrent Review
• Ensure continuity of care from Inpatient to Outpatient
• Utilization review using InterQual
• Insurance and Precertification training
• Appeals processing
• Disease and Case Management
• Coordinated referrals to specialists, hospitalizations, ER visits, ancillary testing, and other enabling services for patients.
• Assessed healthcare needs and monitored effectiveness and progress plans to achieve desired outcomes.
• Arranged transportation and documented details of discharge transition plans.
• Interpreted regulations to identify patient care requirement criteria to be monitored and establish systems to achieve compliance.

• Administered prescribed medication and treatment as permitted by state and local regulations in accordance with physician orders.
• Supported personal care needs, shopping for groceries, and cleaning house.
• Maintained open availability to rotate through on-call periods, night shifts and weekend visits.
• Assisted in development and implementation of service plans related to nursing and patient health care needs.
• Reported general, physical and mental condition of patients to support care initiatives.
• Prepared visit notes, updated and summarized client records and conferred with health care disciplines in providing coordinated client care.
• Changed out tracheostomies, gastrostomy buttons and catheters regularly to prevent infection or other problems.
• Fostered strong relationships with clients and families to support comprehensive social, mental and physical care.
• Wound Care and Home Infusion

• Performed various nursing interventions such as wound dressing, vital sign monitoring, and specimen collection.
• Administered medications via oral, IV, and intramuscular injections and monitored responses.
• Assessed physical, psychological, physiologic, and cognitive status of patients.
• Monitored patients' conditions and reported changes in physical presentation, appearance, and behavior to discuss treatment with physicians.
• Updated patient charts with data such as medications to keep records current and support accurate treatments.
• Collaborated with physicians, pharmacists and therapists to deliver quality, evidence-based care.
• Collected blood, tissue, and other laboratory specimens and prepared for lab testing.
• Implemented medication and IV administration, catheter insertion, and airway management.