- High-Intensity Interval Training
- Passionate about balancing physical health with mental and emotional wellness
- Enjoy hobbies that combine physical activity with outdoor exploration
- Hiking
- Outdoor Recreation
Rachel Cutler
Raleigh/Durham
Summary
Healthcare management professional prepared to enhance operational efficiency and patient outcomes. Skilled in formulating and executing utilization strategies to optimize resource allocation and compliance. Valued for collaborative approach and adaptability, ensuring reliable performance in dynamic environments.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Utilization Manager (PRN) and RN Case Manager (PRN)
Duke University Hospital
01.2023 - Current
- Assesses for accuracy in the assignment of patient class (status) to reflect congruence with clinical condition, physician intent, and utilization review outcomes with current rules and regulatory requirements
- Supports the medical chart audit process by ensuring accurate, timely, and informative clinical review documentation that supports the medical necessity/level of care
- Complies with current rules and regulatory requirements pertaining to utilization management
- Initiates actions to obtain appropriate determinations
- Collaborates with members of the healthcare team to address, understand, and mitigate excess/avoidable days
- Serves as primary source of consultation for issues related to patient class (status) determination
- Validates authorization for all bedded patients
- Validates commercial payer authorization within the contractual timeframe at time of presentation, every third day or as needed
- Manage concurrent cases to resolution care that may impact payer approval to authorize care as medically necessary
- Conducts initial review and continued stay reviews as designated in UM plan
- Reviews records for medical necessity and collaborates with physician(s) and members of the care team to validate information
RN Testing Supervisor
Vault Health
07.2020 - 07.2022
- Company Overview: Vault Health provided the first at home COVID-19 testing kit
- The testing supervisor works in a fast-paced work from home position administering and monitoring COVID testing per policy and procedures
- The testing supervisor virtually facilitates COVID-19 testing through Telehealth visits
- Trained to administer COVID-19 testing virtually through Zoom app
- Ensure and monitor patients perform the test correctly and properly secure the test to be sent in the mail
- Proficient in electronic health records
- Strong communication skills with patients through a virtual environment
- Document COVID-19 screening and procedures for test
- Vault Health provided the first at home COVID-19 testing kit
RN Home Health Liaison
Inova Hospital System
04.2015 - 10.2016
- Assess patient's suitability for home care based on clinical needs
- Ensure referrals are timely, accurate and reflect clinical assessment of the patient as well as the hospital medical record
- Interface with physicians, hospital personnel, intake personnel, and patient/client/family in the assessment, planning and implementation of home care services during patient transition to home care
- Educates interdisciplinary team; case management, nursing, PT/OT/ST, MSW and physicians regarding benefits of Home Health to the patient
- Works within the assigned area and, when appropriate, floats to other Inova facilities as required and determined by the manager
RN Case Manager
Inova Hospital System
03.2015 - 03.2016
- Coordinated/facilitated patient care progression throughout the continuum
- Worked collaboratively and maintained active communication with physicians, nurses and other members of the multidisciplinary care team to effect timely, appropriate patient management
- Completed Utilization Management / Review with patient insurance and Care Management screenings for assigned patients
- Actively participated in clinical performance improvement activities
- Managed all aspects of discharge planning for assigned patients
RN Neuroscience Sub-Acute Care Unit
University New Mexico Hospital
02.2009 - 08.2013
- Worked as a RN on a step-down unit that received patients from the ICU
- The unit specialized in neuroscience, but the unit provided care to various services such as medical/surgical, sub-acute care, epilepsy monitoring, and a specialized room for close observation and high-risk for falls
- Had multiple job duties throughout shift: Provided direct patient care and education to assigned patients
- Assessed patients and collaborated with the healthcare team to provide patient care
- Assisted with tests and procedures and administered medications following the organization's protocol
- Assisted and treated medical emergencies, etc
Education
Master of Science - Nursing Administration
University of New Mexico
Albuquerque, NM05-2012
Master of Science - Nursing
East Carolina University
Greenville, NC12-2008
Skills
- Regulatory compliance
- Utilization review
- Case management
- Problem solving
- Time management
- Communication skills
- Insurance verification
- Medical terminology
- Healthcare regulations
- Case management proficiency
- Cross-functional collaboration
- Healthcare management
- Teamwork and collaboration
- Computer skills
Certification
Certified Case Manager (CCM)
Basic Life Support (BLS)
Interests
Timeline
Utilization Manager (PRN) and RN Case Manager (PRN)
Duke University Hospital
01.2023 - Current
RN Testing Supervisor
Vault Health
07.2020 - 07.2022
RN Home Health Liaison
Inova Hospital System
04.2015 - 10.2016
RN Case Manager
Inova Hospital System
03.2015 - 03.2016
RN Neuroscience Sub-Acute Care Unit
University New Mexico Hospital
02.2009 - 08.2013
Certified Case Manager (CCM)
Basic Life Support (BLS)
Master of Science - Nursing Administration
University of New Mexico
Master of Science - Nursing
East Carolina University
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