APRIL HENDERSON
Herzing University
TN,TN
2
Certifications
10
years of professional experience
Medical Management Specialist – RN guiding utilization management decisions through pre-service and concurrent review, clinical criteria application, and medical necessity evaluation. Coordinates with Medical Directors, case management partners, and providers to escalate nonconforming requests and support timely member care. Maintains accurate documentation and uses MCG, MHK, InterQual, and CMS guidelines to support compliant, cost-effective outcomes.
Work History
Medical Management Specialist – RN
7 Months- Review 10-25 pre-service requests weekly to support medical necessity decisions and timely coverage determinations.
- Coordinate utilization management reviews for medical items and services, aligning determinations with medical policy and clinical criteria.
- Escalate requests that do not meet established criteria to Medical Directors for secondary review and additional clinical evaluation.
- Apply case management principles to assess member needs, coordinate care plans, and support complex medical cases.
- Prepare case presentations, contribute to rounds, and incorporate interdisciplinary recommendations into member care plans.
- Coordinate discharges, out-of-network stabilization, referrals, and confidential documentation with care teams and external partners.
Adjunct Nursing Clinical Instructor
1 Year 1 Month- Guide nursing students through clinical assignments and reinforce safe bedside practices during patient care activities.
- Assess student performance against course objectives and provide clear, actionable coaching throughout the rotation.
- Model professional communication and patient-centered care standards in the clinical setting.
- Support students in developing accurate charting habits and strong clinical documentation practices.
- Observe clinical performance and address knowledge gaps through focused, individualized feedback.
- Adapt instruction to varying student skill levels while maintaining consistent clinical expectations.
- Reinforce therapeutic communication, infection control, and patient privacy during bedside learning.
- Communicate student concerns to course faculty and clinical partners to support timely follow-up.
- Prepare students for clinical expectations by reviewing assignments, documentation requirements, and daily learning goals.
RN Case Manager
9 Years 1 Month- Managed 75 cases weekly in a remote setting while balancing competing priorities and maintaining case management workflows.
- Planned, coordinated, monitored, and evaluated healthcare services with physicians and treatment plans to support appropriate member outcomes.
- Performed prospective, concurrent, and retrospective reviews across inpatient acute care, rehabilitation, referrals, and selected outpatient services.
- Communicated with physicians and colleagues to coordinate case needs, strengthen working relationships, and support continuity of healthcare services.
Education
Bachelor of Science - Nursing (BSN)
Skills
Utilization management
Pre-service & concurrent review
Medical necessity review
Physician escalation
Case management principles
Care coordination
Discharge planning & transitions of care
Interdisciplinary collaboration
Clinical documentation
Medical record review
Meditech
Electronic health record documentation
Medical policy interpretation
Regulatory timeframes
Clinical criteria application
CCM certification
Personal Information
Title: REGISTERED NURSE | MEDICAL MANAGEMENT | UTILIZATION REVIEW & CASE COORDINATION
Certification
Registered Nurse
Timeline
Medical Management Specialist – RN
SCAN Health Plan
03.2026 - CurrentRead More
Adjunct Nursing Clinical Instructor
Herzing University
09.2025 - CurrentRead More
RN Case Manager
Cigna
01.2017 - 02.2026Read More
University of Alabama
Bachelor of Science from Nursing (BSN)
Read More