Wendy Haynes
Summary
Dedicated Utilization Management Nurse with over 15 years of experience in prospective and concurrent reviews, complex discharge planning, Skilled in collaborating with Medical Directors to determine appropriate lengths of stay for complex cases and partnering with Case Managers to facilitate safe, effective discharge plans. Proven ability to work closely with healthcare providers to improve member outcomes, optimize benefit utilization, and ensure appropriate use of healthcare resources while maintaining quality standards. Skilled training and mentoring new staff members.
Overview
40
40
years of professional experience
1
1
Certification
Work History
Utilization Management Nurse
Elevance Health (Anthem)
04.2001 - Current
- PPO, HMO, and Workman Compensation plans.
- Utilization Management
- Telephonic Concurrent and Perspective Reviews
- Onsite Concurrent Reviews
- Complex Discharge Planning for inpatient settings
- Trainer to new staff
- Providing coverage for the supervisor -directing staff, managing workflows
Utilization Management Nurse
Elevance Health (Anthem)
09.1999 - 01.2001
- Medi-cal Plan
- Telephonic Concurrent and Perspective Reviews
- Telephonic Episodic Case Management
Registered Nurse
Kaiser Permanente
02.1991 - 01.1998
- Primary Nurse : ICU, Med/Surg , Pre op and Post Op units
- Managing and providing care to patients
- Providing patient education patients and family members
Clinical Coordinator RN
Kaiser Permanente
01.1986 - 12.1990
- Assisted in opening new Medical Center.
- Writing policies and procedures.
- Clinical Coordinator to 48 bed ICU/CCU/ Tele /DOU for 8 hr shift. Supervised and managed daily activities of clinical team consisting of nurses, and support staff.
Education
Bachelor of Science - Nursing
Bradley University
Peoria, IL5 1984
Skills
- Interdisciplinary collaboration
- Problem-solving
- Adaptability and flexibility
- Decision-making
- Accurate documentation
- Strong Computer Skills including Windows, Microsoft Office Outlook and Teams
- Hipaa compliance
- Insurance Plans
- Electronic health records
Certification
- RN License:
RN California 392501
RN Colorado 1686819
RN Nevada RN81751 - Certified Case Manager, Commission for Case Manager Certification
Timeline
Utilization Management Nurse
Elevance Health (Anthem)
04.2001 - Current
Utilization Management Nurse
Elevance Health (Anthem)
09.1999 - 01.2001
Registered Nurse
Kaiser Permanente
02.1991 - 01.1998
Clinical Coordinator RN
Kaiser Permanente
01.1986 - 12.1990
Bachelor of Science - Nursing
Bradley University