Experienced and detail-oriented RN with a strong background in clinical assessments, patient care management, and medical record review. Skilled in applying MCG (Milliman Care Guidelines) to evaluate medical necessity, ensure appropriate levels of care, and support utilization management and compliance initiatives. Proficient in analyzing clinical documentation for accuracy and quality while maintaining alignment with regulatory standards. Adept at using EMR systems to streamline workflows and enhance interdisciplinary communication. Known for critical thinking, professional integrity, and a collaborative approach to improving patient outcomes in both clinical and administrative settings.