Bonnie Garofalo

Utilization Review Nurse with a proven track record at Ultimate Health Plans, excelling in clinical assessment and documentation. Achieved significant cost reductions by implementing evidence-based practices and mentoring staff. Skilled in InterQual criteria and fostering collaboration, enhancing care delivery and operational efficiency in healthcare settings.

Dependable Utilization Review

Nurse promoting over 40 years of expertise in healthcare industry. Knowledgeable in admissions and stay reviews. Healthcare professional with substantial experience in utilization review and patient care management. Known for precision in evaluating patient treatment plans and making critical decisions to optimize resource use. Valued team collaborator with focus on achieving impactful results and adapting to dynamic healthcare environments.

Utilization Review Nurse - Ultimate Health Plans - Spring Hill, FL

(2021-08)

• Conducted comprehensive reviews of patient care plans to ensure compliance with clinical guidelines.
• Collaborated with healthcare providers to facilitate timely authorizations for medical services.
• Analyzed utilization data to identify trends and recommend improvements in care delivery.
• Educated staff on policies and procedures related to utilization review processes.
• Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
• Fostered a culture of continuous learning by actively participating in departmental meetings, trainings, and continuing education opportunities related to utilization review.
• Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
• Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
• Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
• Submitted cases for criteria failures and helped facilitate resolutions and approvals.
• Led utilization review processes to ensure compliance with healthcare regulations and standards.
• Developed strategies for improving efficiency in review workflows, enhancing overall productivity.
• Collaborated with clinical teams to assess patient care plans and optimize resource allocation.
• Mentored staff on best practices for conducting utilization reviews and documentation accuracy.
• Reduced hospital costs through efficient management of medical resources and implementation of cost-effective strategies.
• Implemented evidence-based practices in the utilization review process, improving overall decision-making accuracy and effectiveness.

Utilization Review Manager - Access Healthcare LLC - Spring Hill, FL

(2014-03 - 2020-12)

• Led utilization review processes to ensure compliance with healthcare regulations and standards.
• Developed strategies for improving efficiency in review workflows, enhancing overall productivity.
• Collaborated with clinical teams to assess patient care plans and optimize resource allocation.

Assistant Director Case Management - Brooksville Regional Hospital - Brooksville, FL

(2000-08 - 2014-02)

• Led strategic initiatives to enhance operational efficiency and streamline project workflows.
• Coordinated cross-departmental collaborations to align objectives and drive organizational goals.
• Mentored junior staff, fostering professional development and knowledge sharing within the team.
• Assisted the Director in developing innovative programs to improve students' academic performance and retention rate.
• Ensured compliance with state education standards by regularly reviewing curriculum materials and teaching practices.

Associate of Science - Nursing - Middlesex College (1977)

No Degree - Nursing Administration - Emanuel College

No Degree - Diabetes Management - Joselin Clinic