Ivory Harris
Baltimore
Summary
Registered Nurse (BSN) with 10+ years of experience in utilization review, case management, and care coordination across hospital, payer, and hospice settings, including experience with UnitedHealthcare and University of Maryland Medical Center. Strong expertise in medical necessity determinations using MCG and InterQual criteria, with a proven track record of ensuring Medicare/Medicaid compliance and supporting favorable review outcomes. Extensive background in utilization review and telephonic review, including prior payer-side experience authorizing services and coordinating care within cost and regulatory guidelines. Skilled in reviewing and summarizing clinical cases, collaborating with interdisciplinary teams, and documenting in Epic to support accurate and compliant decision-making processes.
Overview
15
15
years of professional experience
6021
6021
years of post-secondary education
Work History
Inpatient Hospice Nurse
AccentCare Hospice
Baltimore
02.2023 - 03.2026
- Delivered comprehensive end-of-life care, ensuring comfort, dignity, and emotional support for patients and their families.
- Administered medications (oral, IV, IM) while monitoring patient responses and adjusting care as necessary.
- Coordinated interdisciplinary care plans with physicians, social workers, and chaplains, enhancing collaborative patient management.
Agency Registered Nurse
Medix Staffing
Baltimore
10.2022 - 02.2023
- Collaborated with interdisciplinary teams to optimize patient management, ensuring the best outcomes.
- Performed concurrent reviews using MCG criteria to maintain Medicare compliance.
- Evaluated patient data to pinpoint delays in care delivery and placement, facilitating timely interventions.
Patient Care Coordinator
ProMedica Hospice
Baltimore
10.2020 - 10.2022
- Orchestrated and coordinated comprehensive care for patients and their families.
- Led interdisciplinary group meetings (IDGs) to regularly update care plans, enhancing patient focused outcomes.
- Ensured compliance with state and federal regulations and meticulously reviewed case manager documentation.
Utilization Review Nurse
University of Maryland Medical Center
Baltimore
05.2016 - 04.2022
- Assessed medical necessity using MCG/InterQual criteria, providing evidence-based decisions.
- Documented utilization reviews in Epic, ensuring accurate record-keeping and compliance.
- Collaborated with medical teams, case managers, and payers to facilitate effective care delivery.
- Determined medical necessity as directed by MCG or InterQual criteria for cost-effectiveness of services through utilization review processes.
- Detailed documentation on all utilization reviews by using Epic.
- Referred cases that do not meet MCG criteria to medical director for secondary review.
- Provided utilization review for inpatient level of care, observation and denials Management of assigned patient case load.
- Interfacing with case managers, medical teams, physician advisors and payers.
Telephonic Utilization Review Nurse
United Healthcare
Baltimore
08.2013 - 05.2016
- Monitored care in acute rehabilitation facilities, authorizing continued patient stays as necessary.
- Facilitated referrals for transitional or disease management services, promoting continuity of care.
- Coordinated patient care needs within insurance and cost constraints, ensuring resource efficiency.
Registered Nurse Flex III
Bon Secours Hospital
Baltimore
09.2011 - 04.2015
- Provided direct patient care in the Med/Surgical unit, ensuring high-quality clinical support.
- Designed and managed personalized care plans, discharge instructions, and patient education initiatives to enhance recovery.
RN Case Manager
CareFirst
Baltimore
07.2012 - 08.2013
- Coordinated comprehensive care and discharge planning for patients, improving transition outcomes.
- Acted as a liaison between patients, families, and healthcare providers to facilitate communication.
- Reviewed services and assessed patient needs for home care and medication management initiatives.
RN, Director of Care Delivery
HCR Manor Care Inc.
Baltimore
10.2011 - 04.2012
- Oversaw the management of over 30 patients and staff in the Subacute Unit, ensuring quality care delivery.
- Coordinated direct patient care and continuously monitored departmental activities to uphold standards.
- Ensured efficient staffing, smooth patient flow, and ongoing staff development initiatives.
Education
MBA - Business
Strayer University
WashingtonBS - Nursing
University of Maryland School of Nursing
Baltimore, MDAA - General Studies
Baltimore City Community College
Baltimore, MDSkills
- Utilization Review (MCG, InterQual)
- Medical Necessity
- Case Management
- Intake & Discharge Planning
- Patient Needs Assessment
- Epic
- HCHB
- Medicare/Medicaid Compliance
- Staff Supervision
- Training & Precepting
- Interdisciplinary Collaboration
- Unit Administration
- Healthcare Payor Experience
- Organizational Skills Remote
- Teamwork
License
MD RN License, R165692, 06/28/27
Timeline
Inpatient Hospice Nurse
AccentCare Hospice
02.2023 - 03.2026
Agency Registered Nurse
Medix Staffing
10.2022 - 02.2023
Patient Care Coordinator
ProMedica Hospice
10.2020 - 10.2022
Utilization Review Nurse
University of Maryland Medical Center
05.2016 - 04.2022
Telephonic Utilization Review Nurse
United Healthcare
08.2013 - 05.2016
RN Case Manager
CareFirst
07.2012 - 08.2013
RN, Director of Care Delivery
HCR Manor Care Inc.
10.2011 - 04.2012
Registered Nurse Flex III
Bon Secours Hospital
09.2011 - 04.2015
MBA - Business
Strayer University
BS - Nursing
University of Maryland School of Nursing
AA - General Studies
Baltimore City Community College