Lindsey Crowder
Arkadelphia
Summary
Strategic healthcare professional and RN with 15+ years of experience bridging clinical care, payer relations, and reimbursement operations. Proven success collaborating with medical directors, case management teams, and payers to ensure quality, cost-effective patient care and appropriate utilization. Skilled in navigating coverage policies and claims. Recognized for leadership, cross-functional collaboration, and deep understanding of the intersection between clinical outcomes and reimbursement strategy.
Overview
15
15
years of professional experience
Work History
Clinical Support RN
Arkansas Blue Cross Blue Shield
04.2019 - Current
- Develop and maintain a professional working relationship with client.
- Act as a liaison between the client and multiple internal departments.
- Attend meetings at the request of the Medical Director to provider a nursing perspective within the nursing scope of practice.
- Act as a resource to the Medical Director by researching topics such as medical conditions, medical terminology, medications, lab work medical records, healthcare processes, coverage policies, current plan guidelines, and health/wellness topics.
- Collaborate with key individuals within the benefit department on special projects.
- Collaborate the Medical Director, case management director, case management supervisors, care managers, onsite case manager, account managers, and other internal departments, as well as the client on complex cases utilizing current plan guidelines to research and resolve escalated issues.
- Research client focused services/devices associated with high costs or high utilization
- Research and negotiate pricing with out of network providers when requested by the client. (These are special request only-not negotiations typically done through the normal case management process.)
- Adhere to URAC Management Standards.
- Cooperate and work effectively with all departmental staff to facilitate services to members and providers of care.
- Remain current with medical and surgical procedures, products, services, and medications by attending conferences, home studies, and in-services.
- Monitor effective claims adjudication based on guidelines for contracted services.
- Participate in quality improvement program.
- Prompt case findings which are essential to assure timely transfer to lower levels of care.
- Work closely with hospital discharge planners and home care providers to establish a plan, identify the appropriate setting, including necessary equipment is in place and operational; and that providers are available upon discharge.
- Contact physician to arrange peer to peers for the Medical Director
- Monitor contracted and case by case negotiations with providers for quality of care issues, cost effectiveness, accessibility, and levels of services provided utilizing JCAHO providers when possible.
- Other tasks/projects assigned by Medical Director, Medical Affairs Director, Medical Affairs Manager, or Account Manager
- Call management with providers to discuss EOB, peer to peer, and any issues that may have arisen with member.
Charge Registered Nurse
Centerview Surgery Center/Arkansas Urology
12.2017 - 04.2019
- Patient Assessment
- Patient Education
- Patient Safety
- Responsible for staffing
- Manage the nursing care of all patients that come into the facility
- Delegate tasks when appropriate to licensed staff members
- Coordinate with physicians and assist when needed
- Manage the master schedule
- Encourage a culture that promotes staff productivity
- Ensure that the facility runs efficiently and as per standards and regulations
- Working as part of a team to achieve better patient outcomes
- Manage preop calls to patients for preop screening
Procedure RN
Arkansas Urology/Centerview Surgery Center
03.2014 - 12.2017
- Patient Assessment
- Patient Education
- Patient Safety
- Manage the nursing care of all patients that come into the facility
- Delegate tasks when appropriate to licensed staff member
- Working as part of a team to achieve better patient outcomes
- Serve as Charge nurse PRN
Registered Nurse
Arkansas Heart Hospital Clinic
04.2012 - 03.2014
- Progressive Critical Care Unit
- Assessed, planned, implemented and evaluated patient care
- Patient Education
- Patient Safety
- Prepare and administer medications
- Inserted IVs, catheters, changed wound dressing and administered antibiotics
- Collaborated with professionals across the organization
- Orienting new nurses to the unit
Registered Nurse Circulator
St. Vincents
08.2011 - 04.2012
- Patient Assessment
- Positioning of patients
- Ensure safety of patient while patient is asleep
- Work as a team with other RNs and scrubs to ensure effective care
- Provide emotional support to patients and families
Registered Nurse, Emergency Department
St. Vincents
06.2010 - 08.2011
- Planned care for patients using nursing process
- Planned Discharge and implemented teaching for discharge
- Assess patient and family needs
- Physical assessments
- Act as a team member to perform all ED tasks
- Coordinate care with other healthcare workers and ancillary departments
Education
Bachelor of Science - Nursing
Henderson State University
Arkadelphia05.2010
Skills
- Care Coordination
- Team Supervision
- Quality Assurance
- Research Support
- Medical Recordkeeping
- Resource Utilization
- Patient Relations
- Teamwork
- Ability to work independently
- Active listening
- Analyzing problems
- Call management
- Case management
- Critical thinking
- Mentoring
Accomplishments
- CCM
- Daisy Award Nominee
- supervisor ready assessment completed
Timeline
Clinical Support RN
Arkansas Blue Cross Blue Shield
04.2019 - Current
Charge Registered Nurse
Centerview Surgery Center/Arkansas Urology
12.2017 - 04.2019
Procedure RN
Arkansas Urology/Centerview Surgery Center
03.2014 - 12.2017
Registered Nurse
Arkansas Heart Hospital Clinic
04.2012 - 03.2014
Registered Nurse Circulator
St. Vincents
08.2011 - 04.2012
Registered Nurse, Emergency Department
St. Vincents
06.2010 - 08.2011
Bachelor of Science - Nursing
Henderson State University