Education & Development Nurse | Nurse Informatics Specialist | RN, MSN

Coordinates utilization management orientation for internal and external hires; creates training agendas and materials; delivers approved training presentations; provides client training on system enhancements and functionality; conducts refresher and retraining programs; collaborates with management, quality, and support teams; and assists with system enhancement projects.

Provided clinical expertise for the development and implementation of clinical applications, data, and workflows supporting utilization management and care management. Created technology-enabled process improvements, supported data capture and dashboard reporting, served as a clinical advisor to IT and clinical teams, and provided technical support to clinical teams.

Initiated and managed an auditing program for utilization management clinicians, including audits of outpatient procedures, inpatient admissions, post-acute admissions, behavioral health, and transplant authorizations. Developed training programs, supported company-wide IRRA testing, and established Gold Card auditing tracking and reporting.

Performed concurrent review of clinical information and precertification requests for medical necessity. Coordinated member care, provided disease and medication education, and worked in a fast-paced utilization management environment with strict turnaround requirements.

Triaged, assessed, and monitored emergency patients; delegated tasks; educated patients and families on discharge care; and collaborated with nurses, practitioners, and technicians. Served as Medhost/EDIS superuser, trained staff on documentation systems, and updated systems for changing documentation and regulatory requirements.

Provided post-operative care for vascular, neurological, and gastrointestinal surgery patients. Managed acute high-risk conditions, central and arterial lines, multiple drips and infusions, BiPAP, and tracheostomy/ventilator patients. Floated to ICU and PCCU as needed.

Led quality improvement and workflow initiatives; trained, coached, and mentored staff; performed chart reviews and quality/risk data abstraction; presented results to hospital board members; managed organizational risk and liability; handled patient complaints; and managed practitioner credentialing, privileging, file maintenance, and reappointment tracking.

Provided emergency department and endoscopy nursing care, including patient triage, assessment, acute-condition monitoring, discharge education, and care coordination. Served as Medhost/EDIS superuser and trained students on documentation systems. Precepted final-semester nursing students through hands-on clinical education.