Jeremy Williams
@jeremywilliams1
Experienced RN specializing in utilization management and care coordination.
What I'm looking for
I am a dedicated Registered Nurse with extensive experience in utilization management and care coordination. My career spans over two decades, during which I have honed my skills in managing complex medical cases, conducting concurrent reviews, and authoring appeal letters for denials. I am passionate about ensuring patients receive the appropriate level of care and have a strong background in collaborating with healthcare teams to improve patient outcomes.
Throughout my career, I have worked with various healthcare organizations, including the University of Iowa Health Care Medical Center and Providence Regional Medical Center. My expertise includes utilizing tools such as InterQual and Milliman Care Guidelines, as well as navigating payor portals to support billing processes. I pride myself on my ability to communicate effectively with physicians and care teams to facilitate smooth transitions of care and ensure compliance with CMS guidelines.
As I continue to grow in my nursing career, I am eager to leverage my skills in a challenging role that allows me to contribute to patient care and healthcare improvement initiatives. I am committed to lifelong learning and staying updated with the latest developments in nursing and healthcare management.
Experience
Work history, roles, and key accomplishments
Utilization Management Nurse Clinician
University of Iowa Health Care Medical Center
Jan 2025 - Present (5 months)
Conducted initial, concurrent, and retroactive stay reviews using InterQual, CMS, and hospital policies. Collaborated with physicians and internal teams to ensure appropriate level of care and managed payor notifications and documentation.
Staff Registered Nurse
Rapides Regional Medical Center
Jun 1996 - Apr 1997 (10 months)
Performed clinical tasks on patients on the regular Pediatric floor and the Pediatric Special Care Unit. Served as a staff nurse and an intermittent acting charge nurse.
Nurse Case Manager
Integrated Health Services Home Care
May 1997 - Aug 1998 (1 year 3 months)
Practiced direct patient care for patients in their homes. Served on the Ethics Committee and the Corporate Compliance Committee.
Emergency Department Registered Nurse
St. Francis Cabrini Hospital
Feb 1998 - Jun 1998 (4 months)
Practiced direct patient care in a Level 1 trauma center emergency department. Provided high-acuity care and managed critical patients.
Registered Nurse
Nurse Finders, Inc.
Sep 1998 - Aug 1999 (11 months)
Practiced direct patient care across multiple specialties, including emergency department trauma levels 1-5 and cardiac care. Managed diverse patient acuity levels in various clinical settings.
Emergency Room Nurse
Evergreen Hospital Medical Center
Aug 1999 - Dec 1999 (4 months)
Practiced direct patient care in a Level 2 trauma center emergency department. Provided critical care and managed diverse patient populations.
Medicare Medical Review Analyst
Premera Blue Cross
Jan 2000 - Mar 2001 (1 year 2 months)
Reviewed and investigated Medicare fraud, waste, and abuse through medical record and coding review. Investigated medical professionals regarding billing and coding for Medicare claims and corrected aberrances. Conducted onsite reviews and interviews.
Registered Nurse
Favorite Healthcare Staffing, Inc.
Apr 2001 - Jan 2007 (5 years 9 months)
Practiced clinical nursing across a wide range of specialties including emergency departments, chronic pain, cardiac step-down, recovery, endoscopy, ophthalmology, cardiology, rehabilitation, and home health. Gained experience with multiple electronic health record systems and provided extensive patient and caregiver education.
Utilization Management Nurse
First Choice Health
Jan 2007 - Feb 2009 (2 years 1 month)
Performed prior authorizations for healthcare services and made coverage determinations on concurrent and retrospective hospitalizations. Conducted utilization review, utilization management, and discharge planning. Performed quality assurance, referral management, and process improvement management.
Care Review Clinician I
Molina Healthcare of Washington
May 2010 - Nov 2012 (2 years 6 months)
Performed reviews and made decisions regarding requests for medical services through complex software. Conducted prior authorizations, discharge planning, quality assurance, referral management, and process improvement. Utilized InterQual, coding systems (CPT, ICD-9), and Microsoft Office.
RN Nurse Medical Management II
Anthem Blue Cross (subsidiary of WellPoint)
May 2013 - Nov 2013 (6 months)
Performed concurrent stay reviews of inpatient hospitalizations and utilization review using complex software. Conducted discharge planning, quality assurance, and referral management. Utilized Milliman, coding systems (CPT, ICD-9), and Microsoft Office.
Case Manager I (Concurrent Review)
Coordinated Care (subsidiary of Centene)
Nov 2013 - Feb 2014 (3 months)
Performed concurrent stay reviews of inpatient hospitalizations and utilization review using complex software. Conducted discharge planning and quality assurance. Utilized InterQual, coding systems (CPT, ICD-9), and Microsoft Office.
Registered Nurse Case Manager
Providence ElderPlace (Providence Health & Services)
Aug 2014 - Sep 2015 (1 year 1 month)
Managed complex medical and psychosocial issues for elderly patients in a PACE program. Served on committees for financial rates and skill development. Utilized complex medical software like EPIC and Microsoft Office.
Nurse Auditor (Appeals)
Swedish Health & Services
Oct 2015 - Apr 2017 (1 year 6 months)
Authored appeal letters for encounter-specific denials, working closely with adjusters and claims personnel. Collected data and clinical information post hoc from various service providers. Used evidence-based studies and collaborated with third-party entities for assistance in appealing cases.
Homemaker
Self Employed
Apr 2017 - Apr 2018 (1 year)
Remained at home to provide full-time care for infant daughter. Managed daily household operations and child-rearing responsibilities.
RN Care Coordinator - Utilization Management
Providence Regional Medical Center
Apr 2018 - Dec 2020 (2 years 8 months)
Conducted initial and concurrent stay reviews using InterQual, Milliman Care Guidelines, CMS, and hospital policies. Collaborated with physician advisors and providers to ensure appropriate level of care prior to discharge. Facilitated communication between payors and the facility to guide providers and case management teams on throughput.
RN Care Coordinator – Appeals
Providence Regional Medical Center
Jan 2021 - Jul 2024 (3 years 6 months)
Managed concurrent and retroactive denials, authored appeal letters for various payors, and facilitated peer-to-peer reviews. Collaborated with third parties for legal escalations and utilized platforms including EPIC, InterQual, and Milliman CareGuidelines.
Education
Degrees, certifications, and relevant coursework
Western Governors University
Bachelor of Science in Nursing, Nursing
Completed coursework focused on advanced nursing principles and practices. Gained expertise in evidence-based care and healthcare systems.
Louisiana State University at Alexandria
Associate Degree in Nursing, Nursing
Studied fundamental nursing concepts and clinical skills. Prepared for entry-level registered nurse practice.
Availability
Location
Authorized to work in
Job categories
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