
Registered Nurse with experience in utilization review, case management support, pediatric nursing, and emergency care. Skilled in reviewing clinical documentation for medical necessity, coordinating care across interdisciplinary teams, and ensuring compliance with payer and regulatory guidelines. Experienced working in remote and fast-paced environments, navigating electronic health records, and communicating effectively with providers, patients, and care teams. Multilingual: English, French, Spanish, Portuguese, Akan. Seeking a fully remote Utilization Review or Case Management RN role
•Reviewed patient records to determine medical necessity and level-of-care appropriateness
• Collaborated with physicians and care teams to ensure compliance with clinical guidelines and payer criteria
• Identified opportunities to improve resource utilization and care efficiency
• Maintained accurate documentation supporting regulatory and accreditation standards
• Participated in interdisciplinary utilization review discussions and communicated recommendations
• Provided direct patient care while coordinating admissions, discharges, and transitions of care
• Educated patients and families on diagnoses, medications, and follow-up care
• Documented clinical findings thoroughly in electronic health records
Utilization Review & Medical Necessity Determination
Case Management & Care Coordination
Clinical Documentation Review & Compliance
Discharge Planning
Electronic Health Records (EPIC/EMR)
Interdisciplinary Collaboration
Quality Audits & Regulatory Standards
Remote Communication & Telehealth Support
Multilingual Patient Communication
ADVENTHEALTH ORLANDO 140 HOURS PER SEMESTER
Completed 180 hours of clinical at HCA UCF LAKE NONA MEDICAL CENTER EMERGENCY DEPARTMENT
September 1st 2022- October 31st 2022
TNCC
ACLS/BLS/PALS
IV
EKG