Ruzica Paunic
Knoxville,TN
Summary
Results-oriented Utilization Management Supervisor with a proven track record of optimizing healthcare delivery and enhancing member care at Centene. Expertise in prior authorization, utilization management, and process improvement. Seeking leverage leadership skills to elevate service standards within the healthcare sector.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Utilization Management Supervisor
Centene
05.2024 - Current
- Company Overview: Florida Medicaid
- Supervised 15-18 nurses/referral specialists, driving quality outcomes and optimizing member care
- Oversaw Discharge Planning, Home Health, Private Duty Nursing, and Durable Medical Equipment (DME) for CMS and Medicaid
- Ensured compliance with contractual, regulatory (federal/state), and accreditation requirements
- Provided leadership, support, and coaching to frontline staff, including performance monitoring, feedback, and corrective action
- Conducted training for new associates and retraining on policy and procedure updates
- Prepared reports and completed projects to meet departmental goals and initiatives
- Participated in company and providers meetings, including monthly vendor meetings to address process gaps for DME and Home Health
- Initiated and implemented weekly meetings with supervisors, team leads, and senior nurses
- Provided process improvement recommendations to management
- Served as primary contact for escalations requiring additional research and handling
- Investigated complex issues and proposed solutions
- Conducted interviews and provided input for hiring new candidates
- Florida Medicaid
Clinical Review Nurse – Utilization Management
Centene
01.2022 - 05.2024
- Promoted quality and cost effectiveness of medical care through clinical review of prior authorization requests
- Performed telephonic reviews, approving services or forwarding requests to physicians/medical directors
- Conducted medical necessity and level of care reviews
- Collaborated with provider networks and case management teams to coordinate member care
- Educated providers on utilization and medical management process
- Served as a clinical resource for non-clinical staff
- Maintained clinical information in medical management system (TruCare, MicroStrategy Report, Power BI)
- Collaborated with interdepartmental teams on utilization management projects
- Served as a team lead, assigning and organizing work, managing inventory, monitoring work queues, training new staff, handling escalations, serving as a preceptor, developing training materials, identifying trends, and providing education
OR Circulator Nurse
Tennessee Valley Eye Center
11.2020 - 01.2022
- Developed and implemented personalized patient care plans
- Incorporated evidence-based research into nursing practice
- Ensured adherence to safety principles and practices
- Managed unit resources to optimize service delivery
CVOR Circulator
UTMC
01.2019 - 10.2021
- Developed and implemented personalized patient care plans
- Evaluated patient responses to interventions and nursing care
- Prioritized safety principles and practices
- Responded effectively to emergency situations
- Promoted efficient resource allocation
Registered Nurse
BayCare Alliant Hospital
02.2018 - 11.2018
- Company Overview: LTAC
- Provided independent nursing care, utilizing the nursing process and critical thinking
- Delegated patient care activities
- Communicated effectively with physicians
- Coordinated patient care with case management and therapy teams
- LTAC
Licensed Practical Nurse
Brookdale Senior Living
06.2015 - 12.2017
- Provided compassionate care in assisted living and dementia care settings
- Played a key role in admission planning
- Supervised and mentored new nurses
- Received specialized training in Alzheimer's and Dementia care
- Served as lead nurse on weekend shifts
Licensed Practical Nurse
The Palms of Largo/Regal Palms
09.2014 - 06.2015
- Provided compassionate care in assisted living and dementia care settings
- Organized follow-up appointments and coordinated resources
- Trained and mentored new nurses
- Received specialized training in Alzheimer's and Dementia care
Education
Bachelor of Science -
Western Governors University
Salt Lake City, UT08.2020
Associates of Science - undefined
Saint Petersburg College
Saint Petersburg, FL12.2017
LPN: Nursing - undefined
Gallen College of Nursing
Saint Petersburg, FL06.2014
Skills
- Clinical Assessment Techniques
- Utilization Review Expertise
- MicroStrategy Reporting
- Power BI
- TruCare
- EMR/EHR Navigation
- HIPAA Compliance
- Prior Authorization & Utilization Management
- Team Management
- Training & Mentoring
- Process Improvement Strategies
- Quality Assurance Practices
- Excellent Written & Verbal Communication Skills
Certification
Tennessee RN Multistate License
Languages
Croatian
Native or Bilingual
Serbian
Native or Bilingual
Timeline
Utilization Management Supervisor
Centene
05.2024 - Current
Clinical Review Nurse – Utilization Management
Centene
01.2022 - 05.2024
OR Circulator Nurse
Tennessee Valley Eye Center
11.2020 - 01.2022
CVOR Circulator
UTMC
01.2019 - 10.2021
Registered Nurse
BayCare Alliant Hospital
02.2018 - 11.2018
Licensed Practical Nurse
Brookdale Senior Living
06.2015 - 12.2017
Licensed Practical Nurse
The Palms of Largo/Regal Palms
09.2014 - 06.2015
Associates of Science - undefined
Saint Petersburg College
LPN: Nursing - undefined
Gallen College of Nursing
Tennessee RN Multistate License
Bachelor of Science -
Western Governors University
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