Tracie Smith

• Applied medical criteria and clinical judgment to prior authorization requests to evaluate and make determinations for Inpatient hospital admits, surgeries/procedures, medications, and preventative diagnostic testing
• Referred cases to secondary review for failure to meet medical criteria
• Processed disenrollments for members who are determined ineligible for the medical plan
• Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries
• Determined medical necessity and cost-effectiveness of services through utilization review processes
• Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria
• Process Denials for medical necessity or unable to meet medical criteria

• Oversaw health services for school of 771 students and faculty.
• Obtained students vitals, assessment and treated symptoms or administered medications per MD orders.
• Developed care plans and made referrals as necessary for students with health concerns or injuries.
• Provided medical consultations to other school personnel to promote well-coordinated school health and safety efforts.
• Served as liaison between families, school personnel and other healthcare providers on behalf of students.
• Protected students and school staff from infection by promoting hand hygiene and maintaining sanitary environments in the school and nurse office.

Responsibilities:

• Document all patient assessments, vital signs, nursing notes, nursing diagnosis/care plans in Beaumont hospitals electronic documentation system Epic
• Manage care for post-operative patients from admission through discharge
• Perform physical assessments and nursing care of newborns and infants
• Assist physicians with minor surgeries and non-invasive procedures
• Report to MD and initiated appropriate interventions by reading and interpreting external fetal monitoring strips
• Delegate duties to ancillary staff
• Liaison between patients/family and physicians to ensure comprehension of treatment plans, procedures, and discharge care
• Effective education on disease management, medication purpose/side effects and health maintenance
• Ensure superior patient hospital experience by addressing patient concerns, demonstrating empathy, and problem resolution
• Coordinated and consulted with 4-member health care team to plan, implement and assess both mother and infant care plans