Utilization Management Supervisor - Healthcare Resume Search
Utilization Management Supervisor - Healthcare Resume Search
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Utilization Management Supervisor Resume

Desired Industry: Healthcare SpiderID: 82222
Desired Job Location: Hanover Park, Illinois Date Posted: 9/30/2019
Type of Position: Full-Time Permanent Availability Date: immediately
Desired Wage: 90000
U.S. Work Authorization: Yes
Job Level: Management (Manager, Director) Willing to Travel: Yes, 50-75%
Highest Degree Attained: Other Willing to Relocate: Yes

Highly organized and accomplished professional, offering comprehensive experience in directing clinical

health services and operations; backed by proven success in supervising high-risk NICU insurance and

utilization management operations, while implementing successful programs in the hospital setting

Progeny Health, Plymouth Meeting, PA
Utilization Management (UM) Supervisor Jan 2018–Present
Render keen supervision to a remote team composed of clinical and non-clinical staff
Carried out key functions, such as performance management
Conducted trends and reports analysis to closely monitor workflow and volume
Efficiently handle different markets within one health plan, while organizing meetings with staff, peers,

health plans, and performance manage staff to reduce advanced length of stay in the NICU population
Career Highlights:
Earned selection and recognition for two quarters with peer impressions to the company for the smooth

implementation of a new market and teamwork
Successfully implemented a very large client within three-months of employment

Aetna Better Health of Illinois, Chicago, IL (2015–2018)
Clinical Health Supervisor Dec 2016–Jan 2018
Oversaw the high-risk OB Neonatal Intensive Care members responsible for the utilization management (UM)

and case management (CM) of high-risk pregnancy and NICU-related members
Set strategic direction to a team of four nurses focused on completing cases within the required

turnaround time, while serving as key resource to the HROB/NICU Team and other departments regarding

obstetric and pediatric cases
Facilitated weekly team meetings and weekly medical director rounds, as well as allocated case management

to high-risk OB/NICU members
Took charge of conducting audits, scheduling team meetings, updating key process, working closely with

providers, and acting key point of contact in all medical and NICU concerns
Collaborated with all other departments in ensuring smooth operations of UM and CM departments
Career Highlights:
Successfully established and streamlined guidelines for the Maternity NICU Team’s process
Earned nomination for a silver award for implementing the institution’s mission and values
Played significant roles as team lead and interim supervisor upon leave of the previous supervisor for the

Succeeded in accomplishing the yellow belt certification in the Six Sigma Program

Utilization Management (UM) Clinical Consultant Case Manager | Registered Nurse Apr 2015–Dec 2016
Supported the director and manager on Healthcare Effectiveness Data and Information Set (HEDIS) and

request for proposal (RFP) questionnaire
Thoroughly analyzed all incoming clinical reports to identify admission and continued inpatient stay in

adherence to the Milliman Care Guidelines
Partnered with medical directors and other staff members in managing plan for continued medical stay
Solely maintained daily operations of UM and CM work in compliance with process and workflow
Proactively provided emotional support, education, and guidance to new mothers and high-risk obstetric

Offered effectual assistance to hospital discharge planners in meeting discharge needs

St. Alexius Medical Center, Alexian Brothers Women & Children's Hospital, Hoffman Estates, IL
Registered Nurse | International Board Certified Lactation Consultant Jun 1985–Apr 2015
Delivered quality nursing care to critically ill and premature infants, while creating and executing

individualized care plans
Coordinated with the Medical Team on daily management functions and participated in daily medical rounds
Supervised weekly multidisciplinary planning meetings
Assumed accountability in analyzing patients’ discharge needs, arranging appointments, and educating

Ensured strict compliance with a wide array of guidelines including Joint Commission, Health Insurance

Portability and Accountability Act (HIPAA), Illinois Department of Public Health (IDPH), and American

Academy of Pediatrics (AAP)
Career Highlights:
Succeeded in developing and implementing key programs involving:
NICU-based lactation program that provided optimal outcomes in nutrition and education; and
NICU-based discharge planning program

Associate’s Degree in Nursing
William Rainey Harper College, Palatine, IL

- Professional Development

Cardiopulmonary Resuscitation (CPR) Certification, Valid Until: Sep 2018
Neonatal Resuscitation Program (NRP) Certification, Valid Until: Sep 2018
QNXT and Dynamo Computer Charting Systems, Aetna Better Health of Illinois

Additional Information:
Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel)
QNXT | CareWeb Qi | Dynamo Software | Internet Applications

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