Profile

EMR Support Specialist with a Masters in Healthcare Informatics looking to continue growth in both skill and knowledge in the Health IT field.

Knowledgeable team leader and SME to nurses and coordinators within the organization with 11 years of experience in utilization management, case management, disease management, and appeals.

Experienced leader in Managed Care setting. Known for increasing efficiency, process improvement, and strategically managing nursing teams. Accomplished in execution of strategic initiatives.

Effective people leader that actively supports her team and their growth. Shown to have positive outcomes for members and department using operational and strategic methods.

Areas of Expertise

Healthcare Informatics

Project Execution

Health/Managed Care

Team Leadership

Utilization Management

Nurse Process Improvements

Collaborative Communication

Programming

Problem Solving

Select Achievements

Able to diagnose, troubleshoot and resolve a wide range of software and network issues within the system.

Assisted informatics team to train clinical analyst on inpatient processes within the system.

Provided guidance in development, implementation, and maintenance of company clinical information systems.

Maintains professionalism and courteousness in busy, demanding, and high stress situations.

Computer: MS Office (Word, Excel, Outlook, PowerPoint, Access, Visio), Office 365, Dragon, Citrix, Windows 10, Writing SQL.

Assisted PEGA team with creation of inpatient processes and participated in UATs to give feedback on processes.

Navigated a constantly changing environment during acquisitions and implementations.

Able to meet high volumes of request from providers and implement solutions independently.

Professional Experience & Accomplishments

Health Informatics at Jacksonville University 2015 – 2017

Nurse Analyst, Clinical informatics, System Management

Implementation and management of projects within the mock EHR systems to project completion.

SQL and Netica programming and completion within the informatics program.

Responsible to collaborate with end users to develop and design mock systems utilized in EHRs.

Assessed areas of improvement within the mock EHR system to improve user’s ease of utilizing the system as well as incorporating ways to improve the system to make it more user friendly.

Created User Assessment Tests to analyze the user’s data within the mock EHR system.

WellCare Health Plans/Centene Corporation – Tampa, FL 2013 – 2022

Supervisor, Clinical Care

Oversaw a team of nurses as a Supervisor, while training and counseling new hires. Supervised processes and procedures to ensure compliance with contractual, regulatory (Federal/State) and accreditation entities.

Provided direction and oversight to clinical associates ensuring effective management of inpatient medical necessity review and discharge planning; mentored new leaders.

Proactively sought barriers to achieving desired outcomes, formulate action plans, and follow through. Ex: improving New York market auto approval rate and improve MD review percentage. Best practice results achieved.

Exhibited flexibility and acted as a subject matter expert liaison for health services in support of cross-functional teams to improve total operational performance, decrease turnaround, and decrease overtime.

Created step actions and tools for new senior nurses and supervisors for easy transition and navigation within reporting.

Assisted in optimizing health information systems throughout the company by demonstrating advanced knowledge of clinical processes and supporting technology.

Inpatient Senior Nurse, Clinical Care

Pulled and presented reports on turnaround times, inventory, census counts, and averages.

Monitored the nurses’ performances, productivity and quality through standard reports as needed for the Supervisor.

Investigated issues of an unusual nature and proposed solutions in a clear and concise manner to the Supervisor and provided feedback on unusual cases.

Assisted in training new associates and re-training based on changing policy and procedure.

Ensured that services provided to eligible members are within member’s benefit plan and that appropriate contracted providers are being utilized.

Coordinated with facility discharge planners/utilization management teams for authorizations and/or delivery of post-acute care services including, but not limited to referrals to case and disease management, home health, medical equipment, skilled nursing facilities and other community based services.

Demonstrated appropriate customer care skills such as active listening, consideration, respect, helpfulness, and other skills as recognized.

Determined medical necessity and length of stay within the hospital setting and for discharge planning based on the consistent application of CMS criteria, Interqual criteria, MCG, and Clinical Coverage Guidelines and communicates with Medical Directors for those reviews that are unable to be approved.

eQ Health Solutions – Tampa, FL 2011 – 2013

Team Lead for Telephonic Review and Appeals Nurse for Medicaid and Medicare

St. Joseph’s Hospital, UCH, Home Healthcare – Tampa, FL 2007 – 2011

RN/Charge Nurse, Telemetry Charge Nurse, Pediatric Post Op Nurse

Education BSN Registered Nurse (RN) – University of South Florida – May 2011

MS in Healthcare Informatics – Jacksonville University – December 2017

Certification & Licensure Registered Nurse (RN): Florida State Compact License: # RN9261807

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