In my previous role as a Utilization Manager RN, I was responsible for reviewing patient cases to ensure appropriate levels of care were being provided. I collaborated with interdisciplinary teams to assess patient needs, managed care plans, and ensured compliance with regulatory requirements. My experience includes conducting utilization reviews, identifying potential gaps in care, and implementing strategies to optimize resource allocation.

I prioritize tasks by first assessing the urgency and complexity of each case. Critical cases requiring immediate attention are addressed first, followed by those needing timely intervention. I use a combination of tools, such as electronic health records and task management software, to track and manage workflows efficiently. Regular communication with the care team helps ensure that all cases are progressing as needed.

To ensure compliance, I stay updated on the latest regulatory guidelines and participate in continuous education. I conduct regular audits of patient records to verify adherence to standards and identify any areas needing improvement. Additionally, I provide training to the care team on best practices and regulatory requirements, fostering a culture of compliance within the organization.

When conflicts arise, I facilitate open and respectful communication among team members to understand each perspective. I encourage collaborative problem-solving and seek common ground to align on patient care goals. If necessary, I escalate the issue to senior management for further guidance, ensuring that patient needs remain the top priority.

In a previous role, I identified a trend of readmissions due to inadequate discharge planning. I implemented a comprehensive discharge planning protocol, including follow-up appointments and home care services. This initiative reduced readmission rates by 20% and improved overall patient satisfaction scores. The success was attributed to better coordination and continuity of care.