Summary
Experienced utilization review specialist with a background in behavioral health and case management. Skilled in clinical chart review, communication, and applying medical necessity criteria. Proven ability to coordinate care and advocate for patient needs.
Experience
- Coordinated communication between physicians and payers, reducing authorization delays by 30%.
- Screened 50+ admissions monthly using established criteria, ensuring 98% compliance with medical necessity standards.
- Advised clinical teams on level of care decisions, resulting in a 15% decrease in insurance denials.
- Analyzed treatment plans and progress notes for 100+ patients, identifying documentation gaps and improving approval rates.
- Managed a caseload of 60+ behavioral health clients, coordinating care and supporting discharge planning.
- Applied clinical criteria to coverage determinations, achieving a 95% accuracy rate in benefit approvals.
- Assessed and screened patients for co-occurring mental health conditions, supporting timely and appropriate care.
Education
Courses
- Registered Nurse License, Arizona State Board of Nursing