Experience

CompManagement

• United States
• Insurance
• 1 - 100 Employee

• Mgr of Utilization Management

  • Jul 2013 - Present

  Cincinnati, Ohio Area Manager of Utilization Review and Clinical Authorization Unit Responsible for accuracy, productivity, quality and cost control measures as they relate to the utilization review. Ensures adequate staffing to meet daily departmental needs as well as develops and promotes a team environment. Analyzes management reports related to Utilization Review department’s performance and develops corrective measures as required. Works closely with CHS billing department to help resolve coding and… Show more Manager of Utilization Review and Clinical Authorization Unit Responsible for accuracy, productivity, quality and cost control measures as they relate to the utilization review. Ensures adequate staffing to meet daily departmental needs as well as develops and promotes a team environment. Analyzes management reports related to Utilization Review department’s performance and develops corrective measures as required. Works closely with CHS billing department to help resolve coding and billing issues relating to UR processes. Initiates new and improved workflow processes to help improve efficiency and quality of the utilization reviews processes.

• Utilization Management RN

  • Dec 2012 - Jun 2013



Sedgwick

• Insurance
• 700 & Above Employee

• Mgr of Utilization Management at Sedgwick Managed Care Ohio

  • Jul 2013 - Present



Sheakley

• Manager of Utilization Review

  • Mar 2012 - Dec 2012

  Manager of Utilization review, utilization support and Medical Dispute teams. Responsible for accuracy, productivity, quality and cost control measures as they relate to the utilization review and medical dispute processes. Handles all staffing and HR issues as well as develops and promotes a team environment. Performs annual performance reviews, payroll processing and staffing selections. Meets with state level BWC representatives as well as with other MCO’s to assist with changes and… Show more Manager of Utilization review, utilization support and Medical Dispute teams. Responsible for accuracy, productivity, quality and cost control measures as they relate to the utilization review and medical dispute processes. Handles all staffing and HR issues as well as develops and promotes a team environment. Performs annual performance reviews, payroll processing and staffing selections. Meets with state level BWC representatives as well as with other MCO’s to assist with changes and improvements to guidelines and policies. Helps with billing and coding issues relating to UR processes and MCO billing. Gathers and analyzes data for measuring team performance and develops corrective measures as required.

• Utilization Review Team Leader

  • Apr 2010 - Mar 2012

  Sheakley Responsible for the day to day staffing and HR issues of the Utilization nurses. Responsible for coordinating the UR workflow and ensuring C9s are processed within required timeframes. Monitors and assures the UR team meets both internal and external customer needs. Gathers and analyzes data for measuring team productivity and develops corrective measures as required. Maintains knowledge and applicability of the BWC polices and procedures related to UR team processes. Helps with billing… Show more Responsible for the day to day staffing and HR issues of the Utilization nurses. Responsible for coordinating the UR workflow and ensuring C9s are processed within required timeframes. Monitors and assures the UR team meets both internal and external customer needs. Gathers and analyzes data for measuring team productivity and develops corrective measures as required. Maintains knowledge and applicability of the BWC polices and procedures related to UR team processes. Helps with billing and coding issues relating to UR processes and MCO billing. Work closely with the Medical Dispute department ensuring a smooth workflow from UR to the appeal process. Meets with state level BWC representatives as well as with other MCO’s as needed. Strongly promotes and supports a positive team environment encouraging increased productive and personal growth of the UR nursing staff.

• Utilization Review RN

  • Apr 2006 - Apr 2010

  Sheakley