Terri Brittingham
Manager, Utilization Management Inpatient @Point32Health
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WORK HISTORY
Manager, Utilization Management Inpatient @Point32Health
Leads a team of 13 Registered Nurses overseeing Medicare, Medicaid and commercial Utilization Review operations• Drives compliance strategy for NCQA and CMS audits, ensuring adherence to state and federal regulations.• Participates in process reviews (observation, inpatient, post-acute, readmissions, and retro reviews) and the development of new and/or revised work processes, policies and procedures relating to Utilization Review.• Collaborates with finance and provider relations teams to track utilization trends, support financial furcating, and optimize cost-effective care delivery.• Acts as a liaison with outside entities, including, but not limited to, physicians, hospitals, health care vendors, social service agencies, member advocates, and regulatory agencies.• Develops, reviews, and implements effective administration of Utilization Management workflow and processes in accordance with compliance for regulatory guidelines.• Directs collaboration within cross functional teams to evaluate, refine, and advance the utilization management program and strategy, ensuring alignment with organizational goals.• Leads data driven decision making processes to enhance the outcomes of utilization management teams, resulting in improved efficiency and reduced costs.• Holds weekly team huddles to update team on processes and holds monthly one to one with team members.• Spearheads staff development initiatives, including performance evaluations, mentorship, and compliance training.• Implements performance measures, monitors clinicians’ performance and if necessary, places team members on performance improvement plans.• Assesses candidates for interviews.• Ensures that all new and existing staff are oriented to organizational and department policies and procedures.• Maintains current and accurate files such as licensure and ongoing education status.• Participates in CMS and NCQA audits
EDUCATION
Drexel University College of Nursing & Health Professions Division of Undergraduate Nursing
Bachelor's degree, Registered Nursing/Registered Nurse
West Chester University of Pennsylvania
B.S., Psychology
ABOUT TERRI BRITTINGHAM
I am a dedicated and results-driven healthcare professional with a proven track record in managing inpatient utilization effectively. With a strong background in leadership, I have consistently demonstrated my ability to lead teams, streamline processes, and improve reduction in length of stays making sure safe discharges are in place. Skills- Inpatient Utilization Management- Team Leadership- Data Analysis and Reporting- Healthcare Compliance- Interdisciplinary Collaboration- Process Improvement- Quality Assurance- Strategic Planning
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