Ashley Griffith
WellStar
25
years of professional experience
Seasoned nursing professional offering proven clinical knowledge, interpersonal strengths and technical abilities. Critical thinker and problem-solver. Knowledgeable about EMR charting, medication administration and interdisciplinary collaboration focused on optimizing patient care and support. Quality-focused and efficiency-driven. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Work History
Care Coordinator and Utilization Management Nurse
11 Years 10 Months- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Performed admission reviews based for medical necessity.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Utilization experience in multiple areas including Med/Surg, Critical Care, Mother/Baby, Labor & Delivery, NICU and Women's services.
- Experience with EPIC, MCG, Interqual, Gammis, Availity and other insurance portals.
- Experience with Denials, AOR and Peer to Peers.
- Compliancy with Medicare/Medicaid guidelines
- Care Coordination/Discharge Planning- Set Up Hospice, SNF/LTAC/Rehab, DME, IV Infusion Therapy, Home Health and other discharge needs.
Nursing Unit Manager
1 Year 4 MonthsRegistered Nurse
10 Years 4 MonthsRegistered Nurse Medical/Surgical and Oncology
1 Year 5 Months- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Performed admission reviews based for medical necessity.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Utilization experience in multiple areas including Med/Surg, Critical Care, Mother/Baby, Labor & Delivery, NICU and Women's services.
- Experience with EPIC, MCG, Interqual, Gammis, Availity and other insurance portals.
- Experience with Denials, AOR and Peer to Peers.
- Compliancy with Medicare/Medicaid guidelines
- Care Coordination/Discharge Planning- Set Up Hospice, SNF/LTAC/Rehab, DME, IV Infusion Therapy, Home Health and other discharge needs.
Education
Associate Degree in Nursing - Nursing
Skills
Excellent Time Management
Ability to work independently and self motivated
Team player and willing to help coworkers to even workload and ensure completion.
Take great pride in ensuring health care services are administered with cost efficiency and within compliance.
Comprehensive knowledge of EPIC
MCG
Interqual
Microsoft Word
Outlook and Excel.
Proficient with Insurance portals such as Availity and Gammis.
Well experienced in obtaining authorizations
determining medical necessity
reviewing denials
setting up peer to peers and correcting patient class to match level of care.
Timeline
Care Coordinator and Utilization Management Nurse
WellStar
10.2014 - CurrentRead More
Nursing Unit Manager
Renaissance Center
06.2013 - 10.2014Read More
Registered Nurse
Ga Cancer Specialists
10.2002 - 02.2013Read More
Registered Nurse Medical/Surgical and Oncology
Spalding Regional Hospital
05.2001 - 10.2002Read More
Georgia Perimeter College
Associate Degree in Nursing from Nursing
Read More