Brittany Robertson
Tryon,NC
Summary
Dynamic Remote Utilization Management Nurse with 14 years of extensive clinical experience across various settings, including medical necessity review, denial letter writing, and pediatric inpatient care (PICU, NICU, intermediate). Expertise in applying MCG, CMS, LCD/NCD, and Humana policies to make evidence-based determinations with exceptional accuracy and compliance in turnaround times. Proficient in translating complex clinical information into clear, regulatory-compliant denial letters and supporting appeals. Recognized for strong critical thinking skills, high-volume review capabilities, and a proven track record of excellence in independent remote workflows.
Overview
14
14
years of professional experience
Work History
Utilization Review & Denial Letter Specialist
Cohere Health
01.2023 - Current
- Medical Necessity Review: Prospective, concurrent, and retrospective chart review for inpatient, outpatient, post-acute, and SNF settings
- Maintained high-volume workflow, consistently completing over 4 cases per hour while ensuring accuracy, patient-centered support, and adherence to clinical and payer guidelines.
- .Payer & Clinical Criteria Expertise: MCG, CMS, LCD/NCD, Humana, other commercial and government payer policies
- Denial Letter Writing: Compose clear, compliant, and defensible clinical determinations and appeals
- Clinical Documentation Analysis: Identify gaps, assess appropriateness of care, ensure accurate and evidence-based decisions
- Level-of-Care Determinations: Inpatient, NICU, PICU, intermediate care, post-acute, skilled nursing, and outpatient
- Patient-Centered Review: Apply clinical judgment to support safe, effective, and efficient care coordination
- Care Coordination & Collaboration: Communicate with providers, medical directors, and interdisciplinary teams to clarify documentation and support approvals or appeals
- Regulatory Compliance: Adherence to federal, state, and payer-specific guidelines, policies, and quality standards
- Quality & Metrics: Meet productivity, turnaround-time, and accuracy benchmarks in remote or onsite UM settings
- Clinical Judgment & Critical Thinking: Evaluate complex patient scenarios to determine appropriateness of services
- Documentation Tools: Experience with EMR, chart review platforms, and UM software.
Dupixent MyWay Nurse Educator
Lash Group - Amerisource Bergen/Cencora
11.2019 - 01.2023
- Remote Nursing
- Patient Education & Counseling: Explain treatment plans, injection technique, and therapy adherence strategies
- Medication Access & Prior Authorization: Navigate insurance coverage, benefits investigations, and prior authorizations
- Pharmaceutical Navigation: Coordinate with specialty pharmacies, providers, and payers to remove barriers to therapy
- Care Coordination: Collaborate with interdisciplinary teams to support patient-centered treatment plans
- Clinical Assessment & Monitoring: Track patient progress, side effects, and response to therapy
- Documentation & Communication: Maintain accurate patient records and provide clear updates to providers and care teams
- Chronic Condition Support: Experience with pediatric and adult populations managing asthma, eczema, and allergic conditions
- Patient Advocacy: Support patients and families through complex healthcare systems with empathy and guidance
- Regulatory Compliance: Adhere to HIPAA, payer policies, and pharmaceutical program standards
Registered Nurse / Lab Lead
Parkside Pediatrics
04.2018 - 12.2019
- Administered medications and treatments, ensuring adherence to safety protocols and guidelines.
- Collaborated with multidisciplinary teams to develop and implement patient care plans.
- Conducted comprehensive patient assessments, accurately documenting medical histories and vital signs.
- Educated families on health management strategies, promoting wellness and preventive care practices.
- Streamlined workflow processes, improving efficiency in patient triage and appointment scheduling.
- Led quality improvement initiatives, enhancing overall patient satisfaction and care delivery outcomes.
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Enhanced patient satisfaction by providing compassionate, holistic nursing care that addressed physical, emotional, and spiritual needs.
- Assisted in the training and mentorship of new nursing staff members, contributing to a positive work environment and high-quality patient care.
Charge Registered Nurse
Spartanburg Regional
08.2015 - 04.2018
- Led nursing staff in delivering high-quality patient care and implementing best practices.
- Mentored junior nurses, fostering professional growth and skill development within the team.
- Collaborated with multidisciplinary teams to coordinate patient treatment plans and improve outcomes.
- Conducted thorough assessments of patient conditions, ensuring timely interventions and accurate documentation.
- Streamlined workflow processes, reducing response times for critical care situations effectively.
- Managed inventory of medical supplies, optimizing resources to meet departmental needs efficiently.
- Facilitated training sessions on new technologies and procedures, enhancing team competency and performance.
- Led shift handover meetings effectively communicating critical information about each patient''s status ensuring continuity of care.
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Contributed to a positive work environment by actively participating in unit meetings, sharing ideas to improve efficiency or address ongoing challenges faced by colleagues.
- Coordinated nursing care on unit through staff assignments, assisting and rounding with physicians, monitoring patient orders, and communicating with ancillary departments.
- Mentored newly hired nurses to ensure seamless integration into the team and facilitate their professional development.
- Skillfully performed various clinical procedures such as IV insertion, wound dressing changes, catheterizations; ensuring optimal comfort levels for patients during these processes.
- Enhanced interdisciplinary collaboration through effective communication and teamwork with physicians, therapists, and support staff.
- Built rapport with patients and family members to deliver exceptional care.
Health Science Teacher
Southside High School
09.2017 - 12.2017
- Developed and implemented engaging curriculum aligned with state health science standards.
- Facilitated hands-on laboratory experiences to enhance student understanding of health concepts.
- Collaborated with faculty to integrate interdisciplinary approaches in health education programs.
- Evaluated student performance through assessments and provided constructive feedback for improvement.
- Organized professional development workshops focused on innovative teaching methods in health science education.
- Collaborated with other teachers and administrators to share best practices and implement new teaching strategies for better student results.
- Mentored struggling students through one-on-one tutoring sessions, resulting in significant improvement in academic performance.
- Utilized multimedia resources such as videos, interactive simulations, and online articles to enrich the learning experience for students.
Registered Nurse
Christie Pediatric Group
02.2013 - 08.2015
- Administered pediatric assessments and developed care plans tailored to individual patient needs.
- Collaborated with multidisciplinary teams to enhance patient outcomes and streamline care delivery processes.
- Implemented evidence-based protocols to improve clinical efficiency and ensure adherence to safety standards.
- Educated families on health management strategies, enhancing understanding of treatment plans and compliance.
- Monitored vital signs and managed complex medical cases, ensuring timely interventions for optimal patient care.
- Evaluated patient progress and adjusted care plans based on ongoing assessments and feedback from caregivers.
- Led quality improvement initiatives that increased overall patient satisfaction within pediatric services at the facility.
- Prevented the spread of infections by consistently adhering to strict infection control protocols and educating patients on proper hygiene practices.
- Collaborated with interdisciplinary teams to develop comprehensive treatment plans for complex patients with multiple comorbidities.
Pediatric Nurse
Greenville Memorial Hospital
09.2011 - 01.2013
- Administered medications and treatments in accordance with established protocols.
- Monitored patient vitals, identifying changes and coordinating care interventions.
- Educated families on pediatric health management and wellness strategies.
- Collaborated with multidisciplinary teams to develop individualized care plans.
- Improved patient outcomes through implementation of evidence-based care standards.
- Conducted assessments to evaluate effectiveness of treatment plans and adjust as needed.
- Documented pediatric patient care to maintain accurate and complete medical records.
- Helped young patients feel comfortable with procedures and immunizations.
- Performed advanced clinical skills such as IV insertion, catheterization, and NG tube placement with precision and attention to detail.
- Utilized nursing process to assess, plan, implement and evaluate care.
- Provided emotional support to patients and families to enhance patient experience and promote healing.
Education
200 HR Yoga Teacher Training - Yoga
Asheville Yoga Center
Asheville, NC01.2021
Bachelor of Science -
University of South Carolina (Upstate/Beaufort)
Spartanburg, SC01.2011
Nursing Transfer Student -
York Technical College
Rock Hill, SC01.2008
Skills
- Medical necessity review (prospective, concurrent, retrospective)
- MCG guideline expertise
- CMS, LCD/NCD, and Humana clinical policy interpretation
- Denial letter writing & patient-friendly clinical communication
- Clinical documentation assessment & criteria-based decision-making
- Inpatient pediatric nursing (PICU, NICU, intermediate care)
- Weight-based pediatric medication dosing and acute assessment
- Outpatient pediatric triage, education, and chronic condition support
- Pharmaceutical nurse navigation (PA, benefits investigation, adherence monitoring)
- Lab quality oversight (CLIA, CAP, Joint Commission compliance)
- Specimen handling, QC logs, equipment calibration, SOP development
- EMR proficiency (Epic, Cerner, payer portals)
- Regulatory compliance (NCQA/URAC, HIPAA)
- High-volume remote workflow management & time-sensitive TAT compliance
- Provider communication & interdisciplinary collaboration
- Critical thinking, detail orientation, and documentation accuracy
- Patient and family education
- Independent remote work efficiency & productivity
Timeline
Utilization Review & Denial Letter Specialist
Cohere Health
01.2023 - Current
Dupixent MyWay Nurse Educator
Lash Group - Amerisource Bergen/Cencora
11.2019 - 01.2023
Registered Nurse / Lab Lead
Parkside Pediatrics
04.2018 - 12.2019
Health Science Teacher
Southside High School
09.2017 - 12.2017
Charge Registered Nurse
Spartanburg Regional
08.2015 - 04.2018
Registered Nurse
Christie Pediatric Group
02.2013 - 08.2015
Pediatric Nurse
Greenville Memorial Hospital
09.2011 - 01.2013
200 HR Yoga Teacher Training - Yoga
Asheville Yoga Center
Bachelor of Science -
University of South Carolina (Upstate/Beaufort)
Nursing Transfer Student -
York Technical College