Jamie Tesch

Healthcare Services Supervisor, UM at Molina Healthcare (2023-07 – Present)

• Facilitated productive relationships with stakeholders including physicians, nursing staff, case managers, social workers, payers, patients, families to promote a collaborative approach towards care coordination.
• Developed comprehensive staff training programs to enhance employees' understanding of utilization review principles and practices.
• Improved patient care quality by implementing utilization review processes and ensuring adherence to industry standards.
• Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
• Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
• Supported data-driven decision-making by regularly analyzing trends in resource utilization, identifying opportunities for improvement, and implementing best practices.
• Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
• Increased staff efficiency by providing ongoing education on proper documentation techniques necessary for accurate claims processing.
• Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
• Established team priorities, maintained schedules and monitored performance.
• Evaluated employee performance and conveyed constructive feedback to improve skills.
• Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement.
• Spearheaded implementation of new software systems that streamlined workflow processes within the department leading to increased efficiencies in daily operations.

Clinical Review Clinician at Molina Healthcare (2019-02 – 2023-07)

• Perform utilization review for inpatient services by analyzing patient records to ensure medical necessity, appropriateness of care and level of service according to state and federal regulations using InterQual criteria and Milliman Care Guidelines (MCG).
• Utilize critical thinking to apply review criteria to compile an accurate account of the patient’s clinical circumstances and evaluate the need for continued treatment or alternative levels of care based on the patient's condition and insurance guideline.
• Ensure optimum patient outcomes, reduce the misuse of inpatient services and ensure cost effectiveness while providing effective healthcare.
• Demonstrated strong organizational skills by efficiently managing daily workload, prioritizing tasks based on urgency and importance while maintaining compliance with all state and federal regulations and guidelines.
• Maintained confidentiality when handling sensitive information in accordance with HIPAA regulations.
• Identified opportunities for improvement and assisted with development in processes related to utilization management functions by communicating regularly with internal departments regarding changes in policies or procedures that affect utilization review activities.
• Collaborated with the multidisciplinary team to facilitate quality outcomes while optimizing cost containment strategies and appropriate referrals to other clinical programs.

Staff Nurse | NICU at Ascension St. John Hospital (2017-08 – 2019-02)

• Responsible for the direct care of preterm/term critically ill infants in the Special Care Nursery (SCN) and NICU.
• NRP certified (American Heart Association)

Case Manager/Admissions Nurse at Seasons Hospice & Palliative Care (2016-04 – 2017-08)

• Provided care management to critically ill patients during the final stages of life.
• Thorough understanding of terminal diseases, appropriate comfort care measures, signs of imminent death.
• Ensure death with dignity.
• Strict compliance with Medicare/private insurance guidelines related to hospice care admission and recertification qualifications.

Staff Nurse | CVICU at DMC Harper Hospital (2013-11 – 2016-06)

• ICU (cross trained) Nurse specializing in cardiopulmonary care.
• Experienced Charge Nurse/Clinical Preceptor with excellent leadership skills; serving as a role model and mentor to precept new staff regarding policies, procedures & expectations in the management and care of critically ill patients & high-tech devices/life sustaining equipment.
• Assisted in Interim Clinical Coordinator position.
• Competent in the care of critically ill patients with numerous mechanical life sustaining devices.
• BLS/ACLS certified (American Heart Association)

Bachelor of Science in Nursing – U of M - Flint (2015)

Associate in Science in Nursing – Schoolcraft College (2011 – 2013)