TERRY R. BURLEY, RN, CCM

**** ****** **** ***** 770-***-****)

Loganville, Georgia 30052 acam4t@r.postjobfree.com

SUMMARY

Accomplished professional registered nurse with a strong background in case management, utilization review, discharge planning, and recovery auditing. A proven leader with the ability to affectively handle complex situations in demanding work environments. Consistently recognized for outstanding performance including excellent communication, training, and team lead skills.

PROFESSIONAL EXPERIENCE

PRGX, Atlanta, Georgia 2012 - 2013

Firm that specializes in profit recovery through auditing services.

Clinical Review Specialist / Recovery Auditor

Performed clinical reviews to identify improper Medicare overpayments and potential underpayments.

Performed secondary clinical reviews for determination of upholding denials or overturning cases.

Recovered over $1 billion of improper Medicare payments annually.

Trained staff members to improve productivity and efficiency.

Achieved increasing productivity goals.

STATE OF GEORGIA DEPARTMENT OF COMMUNITY HEALTH, Atlanta, Georgia 2011 - 2012

Department oversees the state’s Medicaid program.

Managed Care Quality Director

Supervised and led a team of four employees in the quality division.

Monitored and documented contractor’s performance and compliance.

CARE IMPROVEMENT PLUS, Atlanta, Georgia 2010 - 2011

Provided insurance to Medicare beneficiaries.

Utilization Review Nurse

Monitored emergency room visits and readmissions and identified high risk members.

Streamlined work processes to improve productivity.

Interviewed candidates for open staff positions.

Performed concurrent clinical reviews and made appropriate determinations for alternate levels of care.

EMORY HEALTH CARE, Atlanta, Georgia 2009 - 2010

Utilization Review Analyst

Determined appropriate admission status for hospital stay.

Obtained and documented clinical information for insurance payers.

UNITED HEALTH GROUP, Atlanta, Georgia 2006 - 2009

Inpatient Care Manager/Advocate

Trained and coached team associates on case load management.

Coordinated outpatient and alternate level of care services for members.

Stream-lined documentation processes.

TERRY R. BURLEY PAGE TWO

INTRACORP, Atlanta, Georgia 2002 - 2005

Utilization Review Nurse

Determined appropriateness of request for inpatient hospital admissions.

Initiated discharge planning discussions and coordinated appropriate outpatient services.

KAISER PERMANENTE, Atlanta, Georgia 1999 - 2001

Registered Nurse

Supervised and oriented new staff members.

Facilitated quarterly staff meetings.

Delegated weekly clinic duties to staff.

GRADY HOSPITAL / FAVORITE NURSES (Contract), Atlanta, GA 1996 - 2002

Staff Registered Nurse

EDUCATION

Master’s in Business Administration: HealthCare Management Concentration,

University of Phoenix, Phoenix, Arizona

Bachelor of Science, Nursing, Valdosta State University, Valdosta, Georgia

Contact this candidate