Tiffany Garvin
@tiffanygarvin
Lead Utilization Management RN delivering compliant inpatient review and audit-driven authorization decisions.
What I'm looking for
I’m an Experienced Lead Utilization Management RN with deep experience in concurrent inpatient review, making medical necessity determinations, and supporting member care through interdisciplinary collaboration. In my current role, I audit authorizations, reviews, and charting to adhere to NCQA guidelines while maintaining TAT by prioritizing and delegating review work.
As a senior clinical review nurse and earlier PACU/Peri-operative RN, I’ve built a strong foundation in patient safety, clinical assessment, and provider communication. I’m also pursuing medical coding and risk adjustment experience—currently supported by my Medical Insurance & Coding Certificate and CPC-A credential—so I can connect clinical insight to coding-focused accuracy and risk-aware outcomes.
Experience
Work history, roles, and key accomplishments
Lead concurrent review clinical work for IA and NE Medicaid inpatient authorizations and reviews. Audit authorizations, manage daily inpatient review assignments, and help maintain turnaround times while supporting interdisciplinary care team conferences.
Perform clinical concurrent review for medical necessity of initial and continued inpatient stays. Coordinate with providers and participate in interdisciplinary care conferences for members with long inpatient stays or discharge planning concerns.
PACU & Peri-operative Nurse
Methodist West Hospital
Mar 2017 - Apr 2019 (2 years 1 month)
Provide peri-operative nursing care focused on patient safety and pre-operative readiness for surgery. Perform nursing assessments, ensure pre-operative checklists are complete, educate patients, and discharge surgical outpatients with safe recovery guidance.
Post-anesthesia Care Unit Nurse
Allen Memorial Hospital
Feb 2016 - Mar 2017 (1 year 1 month)
Provide immediate post-operative care for patients recovering from general anesthesia in the PACU. Maintain airway patency, monitor vital signs, administer IV medications for pain and nausea, and coordinate with anesthesia providers and surgeons.
Float Nurse
Allen Memorial Hospital
Aug 2015 - Feb 2016 (6 months)
Float nurse providing nursing care to multiple patient populations across hospital units. Plan, assess, implement, and evaluate care for 4–6 patients at a time while collaborating with the multidisciplinary team to resolve patient needs and support independence.
Nurse (RN/LPN)
Friendship Village
Oct 2013 - Aug 2015 (1 year 10 months)
Provide geriatric long-term care, including assessments, medication administration, and wound care. Supervise nurse aides and support resident activities of daily living while reporting condition changes to physicians.
Education
Degrees, certifications, and relevant coursework
Louisiana State University Shreveport
Master of Health Administration, Health Administration
2025 -
Currently enrolled in a Master of Health Administration program at Louisiana State University Shreveport (Oct 2025–Aug 2027).
Des Moines Area Community College
Medical Insurance & Coding Certificate, Medical Insurance & Coding
2018 - 2019
Grade: 4.0 GPA
Completed a Medical Insurance & Coding Certificate program (Fall 2018–Spring 2019) and earned a 4.0 GPA.
University of Iowa
Bachelor of Science in Nursing, Nursing
Earned a Bachelor of Science in Nursing from the University of Iowa (Dec 2015), with Dean’s List recognition in Fall 2014 and Spring 2015.
Hawkeye Community College
Associate Degree in Nursing, Nursing
Earned an Associate Degree in Nursing at Hawkeye Community College (July 2014).
University of Northern Iowa
Major in Biology; Minor in Chemistry (did not complete), Biology
2009 - 2010
Studied Biology as a major and Chemistry as a minor at the University of Northern Iowa (Fall 2009–Spring 2010), but did not complete the degree.
Tech stack
Software and tools used professionally
Availability
Location
Authorized to work in
Job categories
Skills
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