Caitlin Lee
Underwood,ND
Summary
Results-driven Registered Nurse and Senior Clinical Reviewer with a strong background in utilization management, clinical case review, training and mentoring, and healthcare compliance. Demonstrated success in resolving complex coverage and medical necessity determinations, improving review processes, and ensuring adherence to regulatory and quality standards. Experienced in training and mentoring staff, providing subject matter expertise, and fostering collaboration across multidisciplinary teams. Known for delivering accurate, evidence-based decisions while promoting consistency, efficiency, and high-quality outcomes in a fast-paced healthcare environment.
Overview
10
10
years of professional experience
Work History
Senior Clinical Reviewer
Noridian
Underwood, ND
05.2026 - Current
- Collaborated effectively with multidisciplinary teams to resolve complex utilization management and coverage determination issues, ensuring timely and accurate outcomes.
- Drove continuous improvement initiatives by identifying opportunities to enhance review workflows, strengthen compliance, and optimize turnaround times.
- Maintained strict adherence to regulatory requirements, organizational policies, and established review protocols to ensure compliance and quality standards were consistently met.
- Mentored and trained new clinical reviewers, facilitating knowledge transfer and supporting successful integration into the team.
- Established and maintained collaborative relationships with clinical and operational partners to support organizational goals and improve service delivery.
- Functioned as a key resource and subject matter expert, providing consultation on complex reviews, interpreting policy requirements, and supporting consistent application of review criteria.
Medical Reviewer
Noridian
Underwood, ND
08.2023 - 05.2026
- Reviewed medical claims for compliance with regulatory standards and guidelines.
- Collaborated with CMDs and other departments to clarify information and resolve any discrepancies.
- Educated providers on errors found during TPE reviews.
- Mentored new reviewers on best practices in medical review processes.
- Served as a subject matter expert demonstrating a strong understanding of regulatory requirements related to medical reviewing.
Registered Nurse
St Alexius Turtle Lake Clinic
Turtle Lake, ND
07.2022 - 08.2023
- Collaborated with physicians to assess patients and deliver appropriate treatment.
- Experience doing Prior Authorization's for various procedures, medications, and treatments.
- Educated patients, families and caregivers about conditions and treatments.
- Evaluated patient histories, complaints and current symptoms.
- Administered different therapies and medications in line with physician orders and treatment plan.
Registered Nurse
Mid Dakota Clinic
06.2017 - 07.2022
- Collaborated with physicians to assess patients and deliver appropriate treatment.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process and management and lifestyle options.
- Provided direct patient care, stabilized patients and determined next course of action.
- Administered medications via oral, IV and intramuscular injections and monitored responses.
- Updated patient charts with data such as medications to keep records current and support accurate treatments.
Registered Nurse, Medical-Surgical Unit
St. Alexius Hospital
08.2016 - 05.2017
- Managed care from admission to discharge.
- Organized and managed care of patients undergoing various therapies and procedures.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process and management and lifestyle options.
- Administered medications via oral, IV and intramuscular injections and monitored responses.
- Provided direct patient care, stabilized patients and determined next course of action.
Education
Associate of Applied Science - Associate Degree Registered Nurse
Dakota College At Bottineau
Bottineau, ND05.2016
High School Diploma -
Lidgerwood Public School
Lidgerwood, ND05.2012
Skills
- Medicare Regulations and Compliance
- Subject Matter Expertise (SME)
- Staff Training & Mentorship
- New Hire Onboarding
- Process Improvement
- Critical Thinking
- Effective Communication
Timeline
Senior Clinical Reviewer
Noridian
05.2026 - Current
Medical Reviewer
Noridian
08.2023 - 05.2026
Registered Nurse
St Alexius Turtle Lake Clinic
07.2022 - 08.2023
Registered Nurse
Mid Dakota Clinic
06.2017 - 07.2022
Registered Nurse, Medical-Surgical Unit
St. Alexius Hospital
08.2016 - 05.2017
Associate of Applied Science - Associate Degree Registered Nurse
Dakota College At Bottineau
High School Diploma -
Lidgerwood Public School
References
Marcy Craythorn, Supervisor, Noridian, 406-880-1142
Amber Mayo, Senior Clinical Reviewer, Noridian, 402-641-7824
Heather Podhraddsky, 701-370-5220