VALERIE VOGEL-TIMBS
Merritt Island,USA
Summary
Experienced and results-driven team member and leader with solid work ethic, skilled at managing teams and ensuring efficient operations. Methodical approach to problem-solving and process optimization, consistently delivering high-quality results with minimal errors. Conscientious in maintaining order and prioritizing tasks, effectively overseeing project timelines and employee performance.
Overview
16
16
years of professional experience
Work History
UTILIZATION REVIEW NURSE SPECIALIST II
LA Care
Los Angeles, CA
06.2024 - Current
- Conducted concurrent reviews for inpatients using Milliman Care Guidelines.
- Utilized clinical judgment to evaluate the need for continued treatment or alternative levels of care based on the patient's condition, diagnosis, and insurance guidelines.
- Applied review criteria to compile accurate accounts of patients' clinical circumstances.
- Managed daily workload efficiently by prioritizing tasks based on urgency and importance.
RN III/ UTILIZATION MANAGEMENT SUPERVISOR/ TRANSITIONAL CARE SUPERVISOR
HEALTH FIRST
Rockledge, FL
06.2011 - 06.2025
- Led a team of RNs to optimize patient care and streamline UR/UM processes.
- Developed policies & procedures to ensure compliance with regulatory guidelines.
- Utilized clinical expertise to review medical records and make appropriate care decisions.
- Managed an interdisciplinary team, facilitated communication, and ensured quality patient care outcomes.
- Led UR process, developed care plans, and coordinated transitional care services.
- Conducted staff training on UM/UR best practices and collaborated with community resources.
- Ensured compliance with regulations, evaluated program effectiveness, and implemented quality improvement initiatives.
- Conducted reviews for both IP and OP.
- Conducted comprehensive medical record reviews for accuracy and compliance with standards.
- Led shifts, delegated tasks, and coordinated care for high-acuity patients.
- Utilized critical thinking skills to make quick decisions and prioritize care.
- Managed patient assignments and staffing levels to ensure safe and efficient care delivery.
- Led unit-based initiatives to improve patient outcomes and increase staff satisfaction.
- Mentored and precepted nursing students and new hires to ensure clinical competence.
- Provide leadership and guidance to the nursing staff daily.
- Ensure compliance with policies, procedures, and regulatory requirements to maintain quality care.
UTILIZATION REVIEW REGISTERED NURSE (CRT RN PCCR)
OSCAR HEALTH
New York, NY
12.2021 - 12.2023
- Maintained accurate records of Utilization Review activities including authorization requests, denials, appeals, grievances.
- Participated in interdisciplinary team meetings to discuss complex cases requiring additional authorization or concurrent review.
- Worked collaboratively with Quality Improvement teams on projects involving utilization review metrics.
- Ensured that all Utilization Review activities are performed within established time frames.
- Utilized computer systems to manage Utilization Review processes efficiently.
- Assisted in developing policies and procedures related to utilization review activities according to state and federal standards.
- Reviewed cases referred from other departments for potential underutilization or overutilization of services.
- Performed concurrent and retrospective reviews of patient health information for accuracy and completeness.
RN/Charge Nurse PCU/ICU
Parrish Medical Center
Titusville , FL
09.2009 - 06.2011
- Administered medications and monitored patient responses effectively.
- Collaborated with healthcare teams on patient treatment plans.
- Educated patients and families on health management practices.
- Assisted in emergency situations with quick decision-making skills.
- Trained new nursing staff on protocols and procedures at the facility.
- Monitored vital signs, administered injections, and provided assistance with medical procedures.
- Adhered to infection control procedures to facilitate safe, clean patient environment.
- Participated in multidisciplinary team meetings to discuss patient care plans.
- Actively participated in quality improvement initiatives within the department.
- Developed educational materials for use in teaching sessions with patients or their families.
- Supervised nursing staff to ensure compliance with hospital protocols and standards.
- Managed staffing schedules to maintain adequate coverage across nursing units.
- Conducted performance evaluations to identify training needs and promote professional development.
Education
BACHELOR OF SCIENCE - NURSING
CHAMBERLAIN COLLEGE OF NURSING
Chicago01.2016
ASSOCIATE OF SCIENCE - NURSING
BREVARD COMMUNITY COLLEGE
Titusville06.2011
LPN - NURSING
BREVARD COMMUNITY COLLEGE
Cocoa12.2002
Skills
- Organizational skills
- Critical thinking
- Conflict resolution
- Leadership
- Communication
- Teamwork
- Problem-solving
- Multitasking
- SME in a multitude of EMR programs
- Quality improvement
- Healthcare regulations
- Utilization management
References
References available upon request
Timeline
UTILIZATION REVIEW NURSE SPECIALIST II
LA Care
06.2024 - Current
UTILIZATION REVIEW REGISTERED NURSE (CRT RN PCCR)
OSCAR HEALTH
12.2021 - 12.2023
RN III/ UTILIZATION MANAGEMENT SUPERVISOR/ TRANSITIONAL CARE SUPERVISOR
HEALTH FIRST
06.2011 - 06.2025
RN/Charge Nurse PCU/ICU
Parrish Medical Center
09.2009 - 06.2011
BACHELOR OF SCIENCE - NURSING
CHAMBERLAIN COLLEGE OF NURSING
ASSOCIATE OF SCIENCE - NURSING
BREVARD COMMUNITY COLLEGE
LPN - NURSING
BREVARD COMMUNITY COLLEGE