Lori Crump, BSN, RN

• Oversaw medical review team operations, ensuring alignment with departmental goals and compliance standards.

Utilization Management Department- specialty carve out team reviewing complex medical necessity, billing/coding/pricing, unlisted codes, benefits and plan language, state legislation, WPATH. Commercial.

• 45 Direct reports (Nurse team and Administrative team). Managed offshore business partner/vendor team (Nurse and case builder team/28).
• Built high-performing team through effective recruitment, onboarding, and talent development initiatives.
• Led cross-functional teams to streamline operational processes and enhance service delivery in a high volume utilization management department.
• Developed and implemented training programs that enhanced staff performance and ensured compliance with industry regulations.
• Collaborated with stakeholders to align project goals with organizational objectives to deliver excellent customer service to Clients, Providers and Members.
• Facilitated regular team and one-on-one meetings to motivate employees and address operational challenges, fostering a productive work environment.

Medical Review Department Manager with 38 direct reports.

Supervised nurse team reviewing medical necessity cases for Tricare, Medicare and Medicaid.