Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Tracey Byars

Rutherfordton

Summary

Insightful Utilization Review Nurse recognized for high productivity and efficiency in task completion. Excel at medical necessity reviews, care coordination, and regulatory compliance, ensuring optimal patient outcomes and streamlined hospital operations. Possess specialized skills in critical thinking, case management, and healthcare policy interpretation. Thrive using empathy, communication, and problem-solving to navigate complex healthcare environments and foster collaborative relationships with healthcare professionals.

Overview

14
14
years of professional experience
1
1
Certification

Work History

RN Case Manager

Rutherford Regional Medical Center
Rutherfordton
06.2024 - 05.2025
  • Coordinated patient care plans across multidisciplinary teams
  • Reviewed patient records for accurate documentation
  • Assisted with discharge planning and follow-up care coordination
  • Communicated effectively with healthcare providers and patients
  • Utilized electronic health records for case management tasks

Utilization Review Nurse

CVS Aetna
High Point
12.2020 - 05.2024
  • Reviewed patient records for medical necessity and compliance with guidelines.
  • Communicated outcomes of reviews to patients and healthcare teams effectively.
  • Assessed patient medical records to determine the appropriateness of requested services and procedures.
  • Evaluated clinical documentation for accuracy and completeness in order to make decisions about coverage determinations.
  • Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
  • Conducted reviews of inpatient utilization for compliance with admission criteria and concurrent review requirements.

RN

Rutherford Regional Medical Center
Rutherfordton
02.2011 - 12.2020
  • Collaborated with physicians to develop and implement patient care plans.
  • Documented patient information accurately in electronic health record systems.
  • Multiple roles and positions were successfully performed during this employment, including RN Case Manager, floor nurse, infusion nurse, and charge nurse.

Education

Associate of Applied Science - Nursing

Isothermal Community College
Spindale, NC
05-2008

Skills

  • Care coordination
  • Discharge planning
  • Utilization review using Interqual and Milliman MCG criteria
  • Electronic health records experience with Meditech, Epic, Cerner
  • Clinical documentation
  • Patient advocacy
  • Interdisciplinary collaboration
  • Time management

Certification

  • Registered Nurse, NCBON Compact License #226258

Timeline

RN Case Manager

Rutherford Regional Medical Center
06.2024 - 05.2025

Utilization Review Nurse

CVS Aetna
12.2020 - 05.2024

RN

Rutherford Regional Medical Center
02.2011 - 12.2020

Associate of Applied Science - Nursing

Isothermal Community College
Tracey Byars