Utilization Review Education Specialist
Resume:
DIANE L. LEVAKE, BSN
Trinity, FL 34655
OBJECTIVE Application of clinical /administrative skills and experience to lead the case management team.
SUMMARY
Over 26 years of increasing responsibility nursing experience in a wide variety of clinical / administrative settings; medical/surgical, telemetry, intensive care and obstetrics for a large multi-facility, hospital group.
Uses excellent communication skills to provide information and establish rapport with medical professionals, patients and families.
Computer Skills: spreadsheets, graphics, word processing, email, internet research and databases.
PROFESSIONAL EXPERIENCE
BayCare Health System
Morton Plant Hospital, Clearwater, FL October, 1995 – Present
Manager of Utilization Review Specialist team June,2021- Present
Leading and directing the utilization review staff at a health care facility, determining procedures and policies that best ensure effective utilization, monitoring reviews to ensure patients receive care, preparing analysis and reports on significant utilization trends, reviewing medical records to help improve patient care; and conducting interviews to determine the patient’s current required services.
Senior Utilization Review Specialist July, 2012- June, 2021
Functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays and the utilization of ancillary services. Responsible for the oversight of the Utilization Review Specialists. Perform other duties as assigned by the supervisor.
Clinical Resource Coordinator June, 2007 – July, 2012
Responsible for providing utilization management and discharge planning functions to enhance the delivery of comprehensive service to patients and families. Determine the appropriateness of hospital admission, utilization of resources and medical necessity for continued stay; facilitates timely discharge; assure medical documentation accurately reflects the patient’s severity of illness, provide appropriate interventions and discharge planning services to patients and families.
A CN III is proficient in the care of a patient population utilizing effective managerial skills. Acts as a professional role model for other members of the nursing and is responsible for developing self and team members and sharing organizational information.
Clinical Education Specialist/CN III April, 2004 – June, 2007
Assessed, developed, implemented and led activities to maintain and improve professional competence and growth of Gynecology team members; designed, implemented and supported team member development; designed creative and interactive learning opportunities; evaluated program outcomes within multiple health systems.
A CN II provides independent, consistent care for a group of patients using nursing processes and clinical standards; delegates appropriate patient care activities to other members of the health care team and is responsible for professional accountability and development.
Mobile Pool Nurse – CN II February, 2001 – April, 2004
Intensive care, telemetry, medical-surgical and obstetrics within various departments rotating through several Baycare facilities.
Obstetrics Nurse – CN II September, 1997 – April, 2000
Responsible for assessment of mother and baby, lab work, IV insertion, medications and patient and family education.
Medical/Surgical Nurse – CN II February, 1996 – September, 1997
Responsible for patient activities of daily living, patient assessment, lab work, IV insertion, medications, patient and family education to enhance their transition to wellness.
Bayfront Medical Center, St. Petersburg, FL
Medical/Surgical Nurse October, 1995 – February, 1996
Responsible for patient activities of daily living, patient assessment, lab work, IV insertion, medications, patient and family education to enhance their transition to wellness.
EDUCATION
Legal Nurse Consultant Program, November, 1996 completion
Kaplan College, Boca Raton, FL
Bachelor of Science, Nursing 1995 completion
State of Florida Registered Nurse #RN2998092
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