Kelly Busbee
NICU Utilization Review Nurse at Centene Corporation- Claim this Profile
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Bio
Credentials
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Certified Case Manager
Commission for Case Manager Certification (CCMC) -
Perinatal Mental Health Certification (PMH-C)
Postpartum Support International
Experience
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Centene Corporation
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United States
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Hospitals and Health Care
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700 & Above Employee
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NICU Utilization Review Nurse
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Nov 2021 - Present
As a NICU Utilization Review Nurse for WellCare of Kentucky, my role was to assess and review the medical necessity and appropriateness of neonatal intensive care unit (NICU) admissions and continued stays. Collaborating with healthcare providers, I evaluated clinical documentation, conducted medical record reviews, and applied evidence-based guidelines to determine if NICU services were justified and in compliance with Medicaid policies. By ensuring that resources were used efficiently, I played a crucial role in optimizing healthcare outcomes for Medicaid beneficiaries while controlling costs. Additionally, I provided education and guidance to healthcare providers regarding Medicaid guidelines and documentation requirements to promote accurate and timely reimbursement. Through this role, I contributed to the delivery of high-quality and cost-effective care for newborns in need of specialized services. Show less
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BlueCross BlueShield of Tennessee
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United States
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Insurance
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700 & Above Employee
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Neonatal Intensive Care Case Manager
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Nov 2017 - Nov 2021
During my time as a NICU Case Manager for Blue Cross Blue Shield of Tennessee, I was responsible for coordinating care plans and advocating for the best interests of our members and their families. With over 11 years of experience in Managed Care Organizations, I developed a deep understanding of the unique challenges faced by NICU patients and their families.In my role, I worked closely with healthcare providers to ensure that appropriate and timely care was delivered to our members. I collaborated with interdisciplinary teams to develop comprehensive care plans tailored to each patient's specific needs. By closely monitoring the progress of these plans, I identified potential gaps in care and implemented interventions to improve outcomes.One of my key strengths as a NICU Case Manager was establishing strong relationships with our members and their families. I provided emotional support and guidance throughout their NICU journey, helping them navigate complex healthcare systems and access necessary resources. By acting as a liaison between the healthcare team and the family, I ensured that they were well-informed and actively involved in the decision-making process.Additionally, I actively contributed to streamlining processes and improving efficiency within our department. I implemented strategies to reduce delays in care, optimize resource allocation, and enhance communication between stakeholders. These efforts resulted in improved patient satisfaction and reduced healthcare costs. During my time at Blue Cross Blue Shield of Tennessee, I maintained my certification as a case manager and sought opportunities for professional development to stay updated with the latest advancements in the field. I was passionate about delivering high-quality care and continuously strived to improve patient outcomes.I am proud of my accomplishments as a NICU Case Manager and the impact I made on patient care. Show less
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Niswonger Childrens Hospital
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United States
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1 - 100 Employee
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Neonatal Intensive Care Nurse
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Feb 2013 - Nov 2017
As a NICU transport nurse, I ensured the safe transportation of newborns who needed specialized care. Collaborating with a multidisciplinary team, we assessed the stability of infants and closely monitored their vital signs during transport. I administered medications and treatments to maintain their health. Providing emotional support to families was a rewarding part of my role, as I offered reassurance, answered questions, and kept them informed about their baby's condition. Staying updated with the latest advancements in neonatal care, attending conferences, and participating in continuing education allowed me to provide the best care. I actively contributed to quality improvement initiatives, participating in meetings, providing feedback, and implementing evidence-based practices. Coordinating transport logistics, arranging equipment, and completing necessary documentation were also part of my responsibilities. Being a NICU transport nurse allowed me to make a positive impact on infants and their families, witnessing their progress and growth. I am grateful for the opportunity to have been a part of their journey towards health and well-being. Show less
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Education
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2009 - 2013
East Tennessee State University
BSN, Registered Nursing/Registered Nurse -
2008 - 2009
University of Tennessee, Knoxville
Pre-Medicine/Pre-Medical Studies
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