Zantipee Jegede
Dover,DE
Summary
Experienced nursing professional bringing demonstrated clinical expertise, leadership skills and technical knowledge. Has a strong background in guiding teams, managing complex projects, and achieving strategic objectives. Excels in developing efficient processes, ensuring high standards, and aligning efforts with organizational goals. Known for collaborative approach and commitment to excellence.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Utilization Management Coordinator
Dover Behavioral Health System
Dover, DE
01.2023 - Current
- Facilitate comprehensive current and extended stay assessments by meticulously conducting reviews at designated times.
- Collaborate closely with assessment and referral teams to ensure up-to-date admission evaluations.
- Prepared appeals to third-party payors, orchestrating collection of vital data to substantiate hospital and patient claims.
- Negotiated extended lengths of stay for patients in the inpatient psychiatry unit, prioritizing individualized treatment plans.
- Managed patient authorizations and ensured compliance with insurance requirements.
- Reviewed medical records to determine medical necessity for services provided.
- Performed clinical assessments including review of medical records to identify potential gaps in care or opportunities for improvement.
- Utilized computer systems such as EMRs, UM software programs and databases to access information relevant to the review process.
- Analyzed medical records to assess whether requested services met criteria based on evidence-based guidelines.
- Conducted utilization reviews for members to ensure services are medically necessary, appropriate and cost effective.
Home Health Nurse
BAYADA
Dover
12.2020 - 01.2026
- Administered medications and monitored patient health to ensure optimal recovery outcomes.
- Developed personalized care plans in collaboration with multidisciplinary teams for comprehensive patient support.
- Educated patients and families on disease management, medication adherence, and preventative care strategies.
- Conducted regular assessments of patient conditions, adjusting care approaches based on changing needs.
- Mentored junior nursing staff, providing guidance on best practices and enhancing team performance.
- Contributed to the overall success of the home health agency by maintaining high levels of patient satisfaction and positive outcomes.
- Streamlined communication between healthcare providers, patients, and families by acting as a liaison for all parties involved in the care process.
- Implemented effective infection control measures within the home setting, reducing risk of illness transmission among family members.
- Served as a reliable resource for families seeking guidance on navigating complex healthcare systems and advocating for their loved ones'' needs.
Registered Nurse Case Manager
Highmark Health Options
Dover, DE
01.2015 - 01.2023
- Addressed all needs of long-term care support patients.
- Displayed a unique ability to contribute to positive and sustained patient well-being.
- Conducted insightful consultations to assess patient needs, leading to development of comprehensive treatment plans.
- Maintained an exceptional 98% compliance rate with all Medicaid requirements for at-risk members.
- Managed caseload of approximately 60-120 at-risk patients, achieving a remarkable 95% positive patient outcome rate.
- Trained new case managers, imparting essential skills and knowledge to ensure proficiency in delivering quality patient care.
Registered Nurse Manager
Bayhealth Kent Campus
Dover, DE
01.2011 - 01.2015
- Led the exclusive stroke-certified Medical Surgical inpatient unit, overseeing a team of 50 RNs and nursing assistants.
- Pioneered 14-bed Medical Surgical inpatient unit from inception to successful completion.
- Achieved an impressive 95% clinical outcomes rate, showcasing exceptional leadership and clinical management skills.
- Launched a cutting-edge outpatient infusion unit, featuring 7 state-of-the-art infusion chairs; successfully garnered multi-million-dollar funding through meticulous proposal and review processes.
- Developed and implemented nursing policies to enhance operational efficiency within the department.
- Ensured compliance with healthcare regulations and safety standards throughout the facility.
- Managed budgetary resources allocated to the department.
- Supported organizational initiatives designed to improve quality of care outcomes.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Achieved departmental goals and objectives by instituting new processes and standards for in-patient care.
Education
Project Management - Project Management
ECornell University
Ithaca, NY05.2025
Master of Science - Nursing Informatics
Walden University
Minneapolis, MN01.2022
Bachelor of Science - Nursing
Delaware State University
Dover, DE05.2008
Skills
Case Management
Appeals & Data Collection
Leadership & Clinical Management
Training & Mentorship
Healthcare Innovation
Regulatory compliance
Home Health Expertise
HIPAA compliance awareness
Critical Thinking
Utilization review expertise
Operations management
Strategic planning
Project management
Epic/OASIS systems
InterQual/NCQA standards
Certification
- Registered Nurse
- Advanced Cardiovascular Life Support
- Basic Life Support
Awards
- Certificate of Excellence Bayhealth
- Nurse of the Year Nominee 2011
Career Experience
- Community Care Nurse, Dedicated Senior Medical Group, 01/2024, Present, Support acute care patients in a community setting to limit readmissions and maintain healthy outcomes.
- Utilization Management Coordinator, Dover Behavioral Health System, 01/2023, Present, Dover, DE, Facilitate comprehensive current and extended stay assessments by meticulously conducting reviews at designated times., Collaborate closely with assessment and referral teams to ensure up-to-date admission evaluations., Prepared appeals to third-party payors, orchestrating collection of vital data to substantiate hospital and patient claims., Negotiated extended lengths of stay for patients in the inpatient psychiatry unit, prioritizing individualized treatment plans.
- Registered Nurse Case Manager, Highmark Health Options, 01/2015, 12/2023, Dover, DE, Addressed all needs of long-term care support patients., Displayed a unique ability to contribute to positive and sustained patient well-being., Conducted insightful consultations to assess patient needs, leading to development of comprehensive treatment plans., Maintained an exceptional 98% compliance rate with all Medicaid requirements for at-risk members., Managed caseload of approximately 60-120 at-risk patients, achieving a remarkable 95% positive patient outcome rate., Trained new case managers, imparting essential skills and knowledge to ensure proficiency in delivering quality patient care.
- Registered Nurse Manager, Bayhealth Kent Campus, 01/2011, 12/2015, Dover, DE, Led the exclusive stroke-certified Medical Surgical inpatient unit, overseeing a team of 50 RNs and nursing assistants., Pioneered 14-bed Medical Surgical inpatient unit from inception to successful completion., Achieved an impressive 95% clinical outcomes rate, showcasing exceptional leadership and clinical management skills., Launched a cutting-edge outpatient infusion unit, featuring 7 state-of-the-art infusion chairs; successfully garnered multi-million-dollar funding through meticulous proposal and review processes.
Accomplishments
- Supervised team of 50-100 staff members.
- Collaborated with team of 30 in the development of 14 bed medical/surgical unit.
Timeline
Utilization Management Coordinator
Dover Behavioral Health System
01.2023 - Current
Home Health Nurse
BAYADA
12.2020 - 01.2026
Registered Nurse Case Manager
Highmark Health Options
01.2015 - 01.2023
Registered Nurse Manager
Bayhealth Kent Campus
01.2011 - 01.2015
Project Management - Project Management
ECornell University
Master of Science - Nursing Informatics
Walden University
Bachelor of Science - Nursing
Delaware State University