Summary
Overview
Work History
Education
Certification
Timeline
Generic

Tracy Lytle

Summary

Dependable and trustworthy professional with strong problem-solving and analytical skills. Committed to continuous growth and learning, demonstrating attention to detail and flexibility. Effectively manages multiple tasks while fostering collaboration and adapting to change.

Overview

10
10
years of professional experience
1
1
Certification

Work History

Compliance Nurse 2- Utilization Review

Humana Healthcare
09.2022 - 06.2025
  • Conducted Electronic and Telephonic UM Team audits for Medicaid Team. Provided monthly electronic reports to UM Team management via Quickbase Software. Partnered with UM Team to remain compliant with NCQA, Humana Corporate and State Medicaid UM requirements. Participated in quarterly UM Compliance and UM Management meeting to collaborate and discuss UM team scores, trends, UM team process changes and feedback.

UM Nurse 2

Anthem BCBS
11.2015 - 05.2022
  • UM Nurse 2 2015-2016 UM Review Nurse (Empire NY Team): Conducted Inpatient and Outpatient UM Clinical Reviews. Assisted in setup of new UM Team Clinical Processes, Completed UM Case Matrix, Maintained 98-100% UM Review accuracy and assignment productivity, Collaboration with Case management for DC planning needs, and identification of high risk and complex health needs. Proficient in MCG, Interqual and Company UM Policies.
  • UM Nurse 2 2016-2018 Outpatient UM Specialized Team (GA). Successfully managed Outpatient UM case load with timely and accurate matrix outcomes. Assisted in redirection to in network providers and facilities when appropriate.
  • Quality Auditor UM 2018-2022: Completed electronic and telephonic clinical quality audits Focusing on safety, clinical effectiveness, productivity and customer service. Provided verbal and written feedback to UM staff and management. Assisted with UM staff performance and outcome improvement. Provided UM Team Trends, shared opportunities for improvement and reports to UM Team and Management. Provided quality process training to UM Team staff.

Education

Bachelor of Science - Nursing

Georgia State University
Atlanta, GA

Certification

  • Certified Case Manager (CCM)
  • Completion of CPC Coding Course

Timeline

Compliance Nurse 2- Utilization Review

Humana Healthcare
09.2022 - 06.2025

UM Nurse 2

Anthem BCBS
11.2015 - 05.2022

Bachelor of Science - Nursing

Georgia State University
Tracy Lytle