Laura Lawton
Flowery Branch
Summary
Results-oriented professional with 14+ years of experience and a proven knowledge of process improvement, leading, training and developing highly engaged teams, provider relations, regulatory compliance and data collection and analysis. Aiming to leverage my skills to successfully surpass expectations and become an asset to your team.
Overview
17
17
years of professional experience
Work History
CASE MANAGER TEAM LEAD
Children’s Healthcare of Atlanta
07.2024 - Current
- Directed training and coaching programs for utilization management nurses and coordinators, improving accuracy in clinical reviews and reducing authorization errors by 25%.
- Developed and delivered curriculum on UM policies, CMS/NCQA requirements, and payer guidelines, strengthening audit readiness and compliance across the department.
- Served as subject matter expert (SME) for UM processes, mentoring new hires and providing ongoing professional development to enhance team expertise.
- Designed onboarding and training materials that reduced new employee ramp-up time by 30% and improved retention.
- Collaborated with leadership and quality teams to integrate audit findings into staff training, decreasing repeat deficiencies by 20%.
Elevance Health Training Team Lead UM &CM
Anthem, FHPS
07.2022 - 07.2024
- Supervision of trainers who assist with the development of nursing orientation programming based on needs assessments and discussions with nursing leaders.
- Provided motivation, guidance and mentorship to help with achieving team goals.
- Developed and implemented policies and procedures.
- Organized group and individual learning activities via lectures, training videos, presentations and demonstration.
- Developed and implemented a new onboarding program for new hires, resulting in a 15% reduction in time to proficiency.
- Led Migration to a new LMS, streamlining the delivery and tracking of training programs for 1,000+ employees.
- Reduction in workforce
MANAGER I CASE MANAGEMENT (UM & CM)
Anthem, FHPS
07.2019 - 07.2022
- Managed Operations for the Utilization Review and Case Management departments, including developing and managing a dynamic team of 25 clinical and non-clinical associates.
- Recruited, hired, trained and coordinated ongoing training for all staff.
- Drove organizational change management strategies during system-wide UM application migration, resulting in 95% end-user adoption within 3 months.
- Provided ongoing coaching and mentorship to utilization management nurses and coordinators, improving accuracy in areas such as prior authorization reviews and denial reduction, contributed to employee satisfaction and a 90% retention rate.
- Used data to monitor key performance metrics(length of stay, readmission rates and prior authorization turnaround times) to identify trends, leading to a 12% reduction in readmissions.
- Developed and updated utilization management policies and procedures to align with NCQA standards, ensuring compliance with regulatory requirements.
- Served as SME in utilization management for cross-functional teams, providing guidance on NCQA, CMS and payer requirements to ensure compliance.
- Promoted
CLINICAL QUALITY AUDITOR (UM)
Anthem Blue Cross Blue Shield
06.2017 - 07.2019
- Improved compliance by 20% through comprehensive audits of utilization review files, ensuring adherence to CMS, NCQA, and payer requirements.
- Led policy and procedure development for UM audits and case reviews, strengthening regulatory readiness and reducing deficiencies identified during external surveys.
- Served as subject matter expert (SME) in UM and clinical quality standards, advising leadership and mentoring staff on regulatory requirements and best practices.
- Designed and implemented audit tools and scorecards, streamlining quality review processes and enhancing reporting accuracy.
- Provided coaching and feedback to staff post-audit, resulting in measurable improvements in documentation accuracy and clinical decision making.
RN CASE MANAGER AND UTILIZATION REVIEW NURSE
Anthem Blue Cross Blue Shield, IHM Commercial
03.2014 - 06.2017
- Successfully managed a caseload of clients, including high-profile cases, demonstrating expertise in insurance law and case management principles.
- Successfully navigated up to 135 complex cases monthly, resulting in a 70% increase in client retention.
- Streamlined end to end UM processes, resulting in a 15% reduction in processing time, which improved efficiency.
- Reviewed and provided up to 35 authorizations per while ensuring compliance with healthcare regulations, decreasing denial rates by 21%.
ACUTE CARE RN: L&D, POST PARTEM, GYN SURGERY AND UNIT EDUCATOR
DeKalb Medical Center
01.2012 - 03.2014
- Provided individualized nursing care to patients in delivery, post partem, and during post-surgical healing, while demonstrating competency using the nursing process by implementing and evaluating patient care based on age specific requirements.
- As an educator: Developed and implemented innovative teaching methods and strategies contributing to improved patient outcomes.
- Demonstrated proficiency in clinical nursing skills and evidence-based practice.
- Led training and development of nursing staff on new equipment and procedures.
ACUTE CARE RN: MED SURGE AND MED SURGE NEURO, GENERAL SURGERY AND OBSTETRICS
Rockdale Medical Center
01.2009 - 01.2012
- Effectively monitored and assessed patients' vital signs, pain levels, and overall condition, providing timely interventions and adjustments to care plans.
- Collaborated with interdisciplinary teams to develop and implement comprehensive care plans, ensuring continuity of care and optimal patient outcomes.
- Expertly performed various nursing procedures, including wound care, dressing changes, and venipuncture, maintaining a high level of accuracy and patient safety.
- Participated in team initiatives to improve patient safety, reduce infection rates, and enhance patient satisfaction.
Education
Master of Science - Nursing
Excelsior College
Albany, NY05.2017
Registered Professional Nurse - undefined
Excelsior College
Albany, NY02.2010
Skills
- Hard Skills: Management and Leadership, Exceptional problem-Solving Skills, Project Management, Microsoft Word, Excel, Project, PowerPoint, etc, Written and verbal communication, Epic and MCG
- Soft Skills: Flexibility, Adaptability, Self-Motivating
Timeline
CASE MANAGER TEAM LEAD
Children’s Healthcare of Atlanta
07.2024 - Current
Elevance Health Training Team Lead UM &CM
Anthem, FHPS
07.2022 - 07.2024
MANAGER I CASE MANAGEMENT (UM & CM)
Anthem, FHPS
07.2019 - 07.2022
CLINICAL QUALITY AUDITOR (UM)
Anthem Blue Cross Blue Shield
06.2017 - 07.2019
RN CASE MANAGER AND UTILIZATION REVIEW NURSE
Anthem Blue Cross Blue Shield, IHM Commercial
03.2014 - 06.2017
ACUTE CARE RN: L&D, POST PARTEM, GYN SURGERY AND UNIT EDUCATOR
DeKalb Medical Center
01.2012 - 03.2014
ACUTE CARE RN: MED SURGE AND MED SURGE NEURO, GENERAL SURGERY AND OBSTETRICS
Rockdale Medical Center
01.2009 - 01.2012
Registered Professional Nurse - undefined
Excelsior College
Master of Science - Nursing
Excelsior College