Congratulations to three employees promoted to leadership positions for Utilization Review, Acute Care Management, and Ambulatory Care Management.
Crystal Hampton, CSW, is the new Divisional Manager Acute Care Management. Crystal has worked as Director of Care Management at CHI Health Good Samaritan for seven years. Previously, she worked the Department of Health and Human Services as a Child Welfare Supervisor. Crystal is involved in the community by serving as a Board member for the Family Advocacy Network, a member of the Good Samaritan Hospital Ethics Committee, and a committee member of the Alzheimer’s/Dementia Group.
Shelley Miller, RN, will be the new Divisional Manager Ambulatory Care Management. Shelley has led the population health coach team in Omaha since 2014, and has led additional team members including discharge transition nurses, disease management, and other clinical support staff in Omaha since June of 2015. Prior to her leadership role, she was a population health coach at the Elkhorn, Gretna, and Eagle Run CHI Health clinics.
In their new roles, Crystal and Shelley will be working to bring the care management resources across the MBO into a cohesive team that will serve as the foundation of population health and value-based care. This one team will then focus on supporting patients throughout the continuum with care management at the bedside, in the clinic, and in their communities.
Bill Brock, RN, was promoted to Divisional Manager Utilization Review/Management for UniNet. Bill was previously a care manager/utilization review nurse for CHI Health. Throughout his career, Bill has held various quality improvement, care coordination, and case management leadership positions for Alegent Creighton Health and multiple payor organizations.
The Utilization Management team is responsible for reviewing a patient’s medical record upon admission to determine the patient’s appropriate level of care in the facility (inpatient, outpatient, or observation). Utilization Management also performs continued stay reviews for evidence of medical necessity, coordinating with the attending provider, physician advisor, case manager or social worker, as well as collaborating with various payor sources as appropriate.
As Divisional Leader, Bill's responsibilities will be across CHI Health, assuring that the Utilization Management teams follow consistent processes to meet insurance and CMS regulations. Bill also will strengthen relationships with our revenue cycle team and with payors to improve the approval/denial process.