Experience

• 

  Belong Health

  • ACO Reach RN Care Manager

    • Feb 2024 - Present

• 

  Carelon

  • Manager

    • Mar 2023 - Feb 2024

• 

  myNEXUS®

  • United States
  • Hospitals and Health Care
  • 100 - 200 Employee

  • Specialty Services Manager

    • Nov 2021 - Mar 2023

  • Clinical Solutions Lead

    • Nov 2020 - Nov 2021

    *Manages day to day operations of the dynamic and fast paced Clinical Solutions team comprised of 3 clinical liaisons and 6 liaison supports, including scheduling, coaching, development/evaluation of employee performance*The Clinical Solution Team is the primary contact to responds to inquiries from ordering physicians (of home health services), home health agencies, members and/or their representatives, and health plan customer services representatives and case managers*Inquiries may be intent to deny notifications, peer to peer requests, denial explanations and/or clerical errors, or education related to the myNEXUS reauthorization process or health plan appeal process *Analyzes data to measure individual/team performance*Collaborates with Clinical Operations leadership to research and correct prior authorization reviews in response to provider/member inquiries, and management/client reporting

  • Behavioral Health Complex Care Manager

    • Feb 2019 - Nov 2020

• 

  UnitedHealth Group

  • Clinical Coverage Review Supervisor, Long-Term Services and Support, UnitedHealthcare

    • May 2018 - Feb 2019

    • Leads a successful team of telecommute Preservice Review RN’s supporting a dynamic environment of clinical coverage review/prior authorization for 8 Medicaid LTSS states: AZ, IA, KS, NJ, NY, KS, TX, VA • Maintains case compliance/contract turn-around-time adherence by monitoring and assigning cases to team members• Provides support, coaching, education to team members via multiple modes of communication – email, instant messaging, one on one meetings, and weekly/monthly and as needed team meetings and trainings• Facilitates discussions regarding clinician scorecards, audit results, development plans with team members • Acts as lead LTSS contact for key states (AZ, IA, KS, TX) for health plan contacts responding to escalations to promote customer satisfaction • Collaborates with a multi-disciplinary team including medical directors, audit team, clinical administrative coordinators, national letter team for leadership, process improvement and prior authorization best practices • Partners with regulatory adherence to ensure accurate reflection of state specific grid requirements and execution of instructions

  • PreService Review RN

    • May 2016 - Apr 2018

    I have the opportunity to support UnitedHealthcare's mission: "Helping People Live Healthier Lives"-Responsible for performing pre-service clinical coverage review of services that require notification, using applicable benefit plan documents, evidence-based medical policy, and nationally recognized clinical guidelines and criteria. -Determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.

• 

  Healthways

  • United States
  • Wellness and Fitness Services
  • 700 & Above Employee

  • Clinical Product Manager

    • Sep 2014 - May 2016

  • Sr. Manager, Clinical Operations and Outcomes

    • Nov 2009 - Aug 2014

  • Healthcare Coordinator

    • Oct 2007 - Nov 2009

  • Member Care Manager

    • Jul 2004 - Oct 2007

• 

  Tennessee Christian Medical Center - Clinical Research

  • Greater Nashville Area, TN

  • Clinical Research Coordinator

    • Aug 2003 - Jul 2004
    • Greater Nashville Area, TN