Katelyn Miles
Garden City
Summary
Detail-oriented and compassionate Registered Nurse with over 8 years of healthcare experience, including direct patient care, case management, and utilization review. Proven leader with a recent focus on training and onboarding new associates in a Subject Matter Expert (SME) capacity within Humana's SNF Team launch. Recognized for adaptability, communication, and process improvement. Actively seeking a leadership role in SNF Utilization Management to continue fostering team growth, quality outcomes, and operational excellence.
Overview
6
6
years of professional experience
Work History
Utilization Review Nurse
Humana
07.2023 - Current
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Provided process education and frontline support for teammates, facilitating real-time resolutions.
- Independently organized and delegated daily assignments for myself and my team while exceeding expected metrics and productivity.
- Promoted to subject matter expert (SME) role in August 2024 for the launch of the Skilled Nursing Facility (SNF) team.
- Lead training for new associates on SNF processes, workflows, and queue management.
Case Manager
AmeriBenIEC Group
02.2022 - 07.2023
- Managed a caseload of 30+ members, coordinating interdisciplinary care plans, authorizations, education, and referrals.
- Reviewed and processed up to 30 authorizations daily during UR assignments.
- Specialized in reviewing requests related to genetic testing, radiation, surgery, and chronic condition care plans.
- Maintained high productivity and accuracy in a fully remote environment.
Registered Nurse
St. Lukes Medical Hospital
07.2019 - 01.2022
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Served as Charge Nurse during shifts, leading clinical operations and supervising staff.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Enhanced patient satisfaction by providing compassionate, holistic nursing care that addressed physical, emotional, and spiritual needs.
- Cared for up to 5 patients per shift in high-acuity environments including ICU overflow.
Education
Nursing
Oregon Health Science University
Portland, OR01-2020
Associate of Science - Nursing
Treasure Valley Community College
Ontario, OR01-2019
Skills
- Clinical assessment
- Interpersonal and written communication
- Prior authorization
- Time management
- Adaptability and flexibility
- Critical thinking
- Utilization management
- Strong clinical judgment
- Teamwork and collaboration
- Organizational skills
- Attention to detail
- Problem-solving abilities
Accomplishments
- Promoted to SME role in 2024 for the launch of the SNF team at Humana. Lead training for new associates on SNF processes, workflows, and queue management.
- Completed Humana's invitation-only leadership course "Emerging Leaders" which was focused on communication, conflict resolution, and leadership styles.
- Successfully managed stretch assignments from direct leader during their absence; managed team queues, delegated team assignments, provided assistance with ongoing questions.
Timeline
Utilization Review Nurse
Humana
07.2023 - Current
Case Manager
AmeriBenIEC Group
02.2022 - 07.2023
Registered Nurse
St. Lukes Medical Hospital
07.2019 - 01.2022
Nursing
Oregon Health Science University
Associate of Science - Nursing
Treasure Valley Community College
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