Deborah G Dendy

• Evaluates medical guidelines and benefit coverage to determine appropriateness of services for hospital admissions.
• Performs prior authorization review of services requiring notification for both inpatient and observation levels of care.
• Submittes cases for criteria failures and helped facilitate resolutions and approvals to payors.
• Submittes initial and concurrent review and data to payors for authorization determinations.
• Clinical review of inpatient and observation cases for medical necessity for admissions and progression of care.
• Documentation of insurance certifications and denials.
• Denial Mitigation with payors and providers.

• Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations, and procedural costs.
• Partnered with physicians, social workers, activity therapists, nutritionists, and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems.
• Monitored clients' progress and tracked client services to provide crisis interventions.
• Evaluated treatment plans against individual goals and healthcare standards.
• Performed Utilization Review nurse duties including: clinical review for medical necessity, concurrent review for progression of care of observation and inpatient admissions, communicating with payors to obtain authorizations, and denial mitigation with payors.
• Identified discharge planning needs, facilitated alternate level of care placements and transfers in coordination with team members, family members and patients.
• Case Management manager for several years then team leader when department restructured until moved to Central UR for HCA. Acted as Interim director on two occasions between directors.

• Level 3 NICU NURSE
• Other areas of expertise: Newborn Nursery, Pediatrics, OB/GYN, and Post Partum.
• Floated to other units when facility needs arose: Medical Surgical, Telemetry and Stepdown units. Outpatient surgery, radiology nursing and Endoscopy.
• Participated in team projects, demonstrating an ability to work collaboratively and effectively.
• Precepted new employee's
• Clinical management of NICU/Nursery Staff Including scheduling, payroll, ordering supplies, shift assignments, evaluations.

Registered Nurse, managed care of patient's preoperative and postoperative for Plastic Surgical Center