Summary
Overview
Work History
Education
Skills
Accomplishments
Affiliations
Certification
Timeline
Generic
TABATHA DEGREE

TABATHA DEGREE

Shelby,NC

Summary

Dynamic Utilization Review Nurse at Atrium Healthcare with expertise in InterQual and Milliman criteria and a strong commitment to ethical practice. Proven ability to enhance patient outcomes through effective teamwork and critical thinking. Skilled in electronic health records and adept at navigating complex regulatory environments, ensuring compliance and optimal care delivery.

Overview

21
21
years of professional experience
2
2
Certification

Work History

Utilization Review Nurse

Atrium Healthcare
10.2018 - Current
  • Learned to review patient records for medical necessity and appropriateness of healthcare services.
  • Assisted in gathering clinical information for insurance coverage determinations.
  • Supported communication between healthcare providers and insurance companies regarding treatment plans.
  • Developed understanding of regulatory requirements and guidelines in utilization management.
  • Gained proficiency in utilizing electronic health record systems for data entry and retrieval.
  • Collaborated with multidisciplinary teams to support optimal patient care decisions.
  • Adapted to changes in protocols and procedures within the utilization review process.
  • Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
  • Submitted cases for criteria failures and helped facilitate resolutions and approvals.
  • Assisted discharge planning efforts through prompt identification of medically stable patients who were ready for transition to alternate levels of care.
  • Demonstrated commitment to ethical practice by upholding patient confidentiality and advocating for individual rights in all interactions with stakeholders.

Registered Nurse

Carolinas Medical Center
06.2004 - Current
  • Administered patient care, ensuring adherence to safety protocols and best practices.
  • Collaborated with interdisciplinary teams to develop individualized care plans for diverse patient populations.
  • Monitored vital signs and assessed patient conditions to identify changes requiring immediate intervention.
  • Educated patients and families on health management and post-discharge care strategies.
  • Cardiac Care Nurse
  • Observation Care Nurse
  • Nursing Administration
  • Assistant Nurse Manager
  • Crossed trained in ED nursing and L&D

Unit Educator

Atrium Healthcare
02.2010 - 09.2018
  • Developed and implemented differentiated instruction strategies for diverse learners, ensuring individualized attention and success.
  • Utilized data-driven instruction to target areas of weakness and continuously improve patient outcomes.
  • Met regularly with team of leaders to discuss best practices and develop innovative teaching strategies.
  • Created and implemented yearly team competencies to measure team compliance and understanding.
  • Lead and actively participated in Shared Governance.

Education

Master of Science - Nursing Education

Queens University of Chartotte
Charlotte, NC
08-2021

Associate of Science - Nursing

Winston-Salem State University
Winston-Salem, NC
05-2014

Associate of Science - Nursing

Gardner-Webb University
Boiling Springs, NC
05-2004

Skills

  • Proficient in InterQual criteria
  • Utilization management expertise
  • Teamwork and collaboration
  • Time management
  • Attention to detail
  • Multitasking
  • Excellent communication
  • Critical thinking
  • Strong clinical judgment
  • Adaptability and flexibility
  • Electronic health records
  • Microsoft office
  • HIPAA compliance
  • Application of Milliman guidelines

Accomplishments

  • Collaborated with team in the development of 10 hour shifts.
  • Developed project to reduce observation length of stay by focusing on the 2 midnight rule and other strategies to appropriately advance patients to inpatient.
  • Awarded Senior Care Manager 2 consecutive years for leadership within the department, 2023 and 2024.
  • Chosen to attend Magnet conference in 2023 by Magnet Director for recognized work within Magnet workgroup.


Affiliations

  • NCNA
  • ACMA

Certification

  • ACM CERTIFIED 2021 TO PRESENT
  • MED-SURG CERTIFIED 2015 TO PRESENT


Timeline

Utilization Review Nurse

Atrium Healthcare
10.2018 - Current

Unit Educator

Atrium Healthcare
02.2010 - 09.2018

Registered Nurse

Carolinas Medical Center
06.2004 - Current

Master of Science - Nursing Education

Queens University of Chartotte

Associate of Science - Nursing

Winston-Salem State University

Associate of Science - Nursing

Gardner-Webb University

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