Cruhn Kell

Being a Registered Nurse with a BSN and CCMC certification, I have vast experience with advocating for patients. I have been a Utilization Review Nurse since 2010 and have worked both in the hospital setting and Insurance. Regarding my insurance experience, I have worked with Commercial payers and MCOs, all lines of business including Medicare, Medicaid, Duals, and Commercial insurance.

I have also worked with every level of care from planned inpatient, Inpatient, Post-Acute, Outpatient, and DME, this offers me the ability to manage and assist every patient at every level of care. I know I would add value and be an asset to your team.

Clinical Information Specialist / CareSync Trainer at Molina Healthcare (2022-12 – Present)

• Serve as the Clinical Information Systems team's sole CareSync trainer, independently developing expertise in the platform and supporting onboarding and go-live activities.
• Create clinical systems communications, documentation, videos, quick reference guides, and system guides for CareSync in collaboration with the Training team.
• Review clinical workflows, support EMR use, and escalate system issues as needed.
• Support initiatives involving Pega, mCare, CareSync, Availity, and business partners while managing project tasks, timelines, and operational readiness activities.
• Review Jira tickets to identify trends, gaps, and resolution needs.

Corporate Clinical Trainer at Molina Healthcare (2022-08 – 2022-12)

• Delivered training for Medicare, Medicaid, and Medicare-Medicaid Plan programs.
• Identified system gaps and collaborated with project management, Pega development, and IT teams to improve communication and support solutions.
• Created policies, procedures, learning modules, and training videos within established timelines.

Utilization Manager / Trainer at Innovista Healthcare (2019-01 – 2022-07)

• Developed training programs and supported system functionality for health plan operations.
• Partnered with IT and development teams to define user stories and support the design and implementation of a new utilization management tool.
• Served as the subject-matter expert for MCG and Epic, providing guidance on system use and utilization management workflows.

Case Manager / Utilization Reviewer at DuPage Medical Group (2015-12 – 2019-12)

• Updated documentation to align with NCQA standards and supported audit preparation activities.
• Supported the implementation of a new EMR system and trained staff on effective system use.
• Consistently met business expectations and established performance metrics.

Team Lead, Custom Team at UnitedHealthcare (2007-07 – 2015-11)

• Led cost-impact analysis, member support activities, and workflow coordination for the Custom Team.
• Conducted annual and post-implementation time studies to evaluate workflow efficiency and resource needs.

Bachelor of Science in Nursing – Saint Xavier University