Summary
Registered nurse with 5 years in utilization management and case management. Skilled in medical coding, clinical documentation improvement, and care coordination. Proven ability to analyze service requests and ensure compliance with payer guidelines in remote environments.
Experience
- Reviewed 60+ clinical service requests weekly, maintaining 97% compliance with evidence-based guidelines.
- Accessed payer portals to secure authorization numbers, reducing processing time by 18%.
- Addressed lab-related escalations, resolving 90% of cases within 48 hours.
- Analyzed documentation data to identify trends, leading to a 15% reduction in errors.
- Collaborated with case management and care coordination teams to improve patient outcomes.
- Managed care for 100+ patients monthly, reducing unnecessary hospital admissions by 12%.
- Supported clinical documentation improvement initiatives, increasing audit pass rates by 10%.
- Trained 3 new nurses on utilization management protocols.
Education
Courses
- Registered Nurse (RN) License, California Board of Registered Nursing
- Certified Case Manager (CCM), Commission for Case Manager Certification