Deborah A.

Weitzel, RN, BSN

3508 Orbitan Road.
Baltimore, Maryland 21234
Home: 410-663-9827
Mobile: 443-570-0314 Office: 443-694-9479
E-mail: dw927ebe@westpost.net
Education:
1993-98 Masters Credits Neonatal Clinical Specialist
1993 University of Maryland at Baltimore, Baltimore, Maryland (BSN)
1990 Dundalk Community College (part of CCBC), Baltimore, Maryland (AA)
Experience:
4/08-Present Manager Healthcare Management Services-Utilization Management
AMERIGROUP Community Care (MD Medicaid/Medicare MCO) Hanover, MD
* Monitors utilization management activity and reports on trends to the Director
/AVP according to established standards; takes appropriate action to ensure comp
liance with requirements
* Coordinates utilization management workload based on acuity levels
* Facilitates early case findings by daily rounds with onsite concurrent review
staff
* Ensures utilization management decisions are based on AMERIGROUP's clinical po
licy and approved criteria, including Milliman Care Guidelines & InterQual
* Evaluates utilization management staff on an ongoing basis in conjunction with
Director/AVP and implement corrective action as indicated
* Implements and evaluated utilization management procedures within the guidelin
es of established policies
* Acts as a resource for staff on decision making and problem-solving in accorda
nce with AMERIGROUP's policy & procedures and approved criteria
* Evaluates current processes with other management personnel; recommend & promo
te changes for increased efficiencies and improved outcomes
* Assists in development of training and ensures adequate training is provided f
or new & current staff
* Maintains accurate reporting to assure compliance with departmental standard a
nd policies
* Ensure department staffing at all times; re-assign staff responsibilities to e
nsure effective resource utilization
* Acts as information technology user expert for utilization management departme
nt.
* Coordinate activities within the plan including case management, quality manag
ement, substance abuse, and service center
* Day to day management of inpatient services for both the Maryland and Northern
Virginia plans.
* Direct daily supervision of 22 + employees.

1/05-4/08 Concurrent Review Nurse/Discharge Planner

AMERIGROUP Community Care (MD Medicaid MCO) Linthicum, MD
* Onsite and telephonic concurrent review to determine medical appropriateness o
f acute medical, NICU, sub acute, rehab, & SNF admissions & continued services
* Use of InterQual criteria and/or Milliman Care Guidelines as guides for level
-of-care (LOC) appropriateness determinations
* Acute care discharge planning & care coordination
* Data entry & record maintenance for all assigned conditions using Amisys, Face
ts (Feb 08) InterQual/Cerme software, as well as excel spreadsheets, Access data
base.
* Interdisciplinary rounds/interface for review, assessment, & planning for inpa
tient clients
* HIPAA compliance regarding all confidential patient information
* Single case fee negotiations with non-participating providers
* Compliance with MD state MCO disenrollment procedures
* Onsite concurrent review for all patients (excluding psychiatric) at Sinai Hos
pital and several other Baltimore area acute care hospitals

Clinical Experience
Per Diem contract nurse, Center for Neonatal Transitional Care. Mount Washington
Pediatric Hospital [4/2003-12/04]
Agency Nurse NICU/PICU [10/99-12/04]
NICU, PICU, Newborn Nursery, Labor and Delivery & Post partum/Antepartum Staff N
urse with Charge Duties [6/93-10/99]
Licensures & Certifications
* Maryland RN Licensure (R119487 exp. 11/10)
* CPR (3/2010)
* PALs ( to renew 6/2010)
* NRP ( require current recertification)
* Certified Bikram Yoga Instructor
Related Skills
* Proficient use of Windows 2000, & XP (& XP Home Edition), Microsoft Office Sui
te 2007 (including Word, Excel, Access, & PowerPoint); 35 WPM typing; proficient
with, Amysis, (interactive) InterQual, (interactive) Milliman Care Guidelines,
and FACETS; excellent independent worker with exceptional analytical and organiz
ational skills .