RN-UM CCR Supervisor

Tiffany R. Ouellette, RN, BSN

*** ******* **. **********, ** 46140

*******@*****.*** 317-***-****

Indiana License # 28194966A

SUMMARY

Experienced RN familiar with Medicaid, Medicare and Marketplace insurance. Proven leader in ensuring timeliness of schedule creation and delivery to the standards set out by the Director/Manager and expectations of the business unit. Skilled in collaborating with internal and external patient advocates to ensure seamless transition to the most appropriate level of care

EXPERIENCE

Utilization Management Supervisor

Managed Health Services- Indianapolis, IN October 2019 – Current

Supervise the daily operations of the utilization management department including but not limited to; staff schedules attendance and workload, ensure compliance within applicable state program guidelines, ensure appropriate usage of resources in order to facilitate the UM process, educate staff as necessary to ensure consistent performance and adhere to standards, assist UM Manager and Director with coordinating and facilitating system processes with providers, partners, vendors and subcontractors as needed, other duties as needed.

Quality Improvement Coordinator II

Managed Health Services- Indianapolis, IN February-2015 – October 2019

Conduct review of delegated entities for compliance with quality, service performance and medical record auditing in order to help close care gaps. Assisted in managing the 2017 - 2019 P4P/HEDIS project by interviewing, hiring, training and supervising of temporary nursing staff. Acting liaison between corporate/staff and vendor/staff. Clinical subject matter expert. Review and presentation of Quality-of-Care cases received in regards to our members.

Nurse Consultant

Family Social Services Administration, State of Indiana- Indianapolis, IN March-2012 – February 2015

Review of medical records to determine eligibility for Medicaid disability as per guidelines set forth by Social Security Disability Administration. Presentation of denials to medical director.

Registered Nurse

St. Vincent Anderson Regional Hospital- Anderson, IN July-2011 – March 2012

Provided direct patient care in accordance with the Indiana State Nurse Practice Act, Identifying and prioritizing health problems based on assessments of patients in the respiratory and oncology unit.

Home Care Nurse

Pediatric Nursing Specialists- Indianapolis, IN October 2011 – March 2012

Providing one on one care to pediatric patients with a wide variety of medical issues including trachs, G-tubes, and portable ventilators on a PRN basis.

Registered Nurse/Transitional Care

Kindred Healthcare-Greenfield, IN March 2011 – July 2011

Providing continuing care to patients who are recovering from an illness or continuing to rehabilitate, which includes but not limited to: IV therapy, complex wound care, enteral feedings, and other rehabilitation services.

Claims Adjuster

Conseco Insurance (LTCG/Univita)- Carmel, IN July 2005 – March 2011

Processing of Long-Term Care claims involving interpretation of medical records and a variety of regulatory materials as per state and federal guidelines; training of fellow employees.

EDUCATION

RN to BSN

Western Governors University, Millcreek UT

Graduated 2023

Associate of Science in Nursing

Med Tech College Indianapolis, Indiana

Dean’s list 2008-2010, GPA-3.8

SKILLS

Effective Leadership

Parent/Patient/Family Education

Time management

Ability to work independently or as a team

Proficient with various software applications

Chart auditing

Planning and research

Communication

Conflict resolution

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