Deirdre Berrebie

• Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
• Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
• Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
• Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
• Performed prior authorization review of services requiring notification and concurrent review for continued authorization.
• Facilitated workgroup meetings with medical personnel to find effective solutions to issues.
• Mitigated potential legal issues related to improper admission or discharge decisions by consulting with physicians regarding complex cases that required further clarification.
• Improved patient care quality by conducting thorough utilization reviews and making recommendations for optimal treatment plans.
• Contributed to organizational success by providing expert advice on medical necessity criteria and evidence-based practices in utilization review nursing.
• Served as a vital liaison between patients and healthcare providers, fostering effective communication and coordination among all parties involved in the care process.
• Minimized financial risk associated with denials or payment discrepancies through diligent validation of medical necessity prior to service provision.
• Fostered a culture of continuous learning by actively participating in departmental meetings, trainings, and continuing education opportunities related to utilization review.
• Assisted discharge planning efforts through prompt identification of patients who were ready for transition to alternate levels of care.
• Streamlined the case management process by effectively prioritizing high-risk cases for timely intervention and followup.
• Promoted positive outcomes with proactive assessment of patients' needs and development of targeted interventions to address identified barriers to recovery.
• Demonstrated commitment to ethical practice by upholding patient confidentiality and advocating for individual rights in all interactions with stakeholders.
• Devise or identify solutions for irregular requests and issues.
• Supported data-driven decision-making by regularly analyzing trends in resource utilization, identifying opportunities for improvement, and implementing best practices.
• Supported organizational growth and development through effective collaboration with interdisciplinary teams focused on improving the quality, safety, and efficiency of healthcare delivery.
• Supported healthcare equity by identifying and addressing gaps in care for underserved populations.
• Enhanced patient care coordination by effectively communicating review outcomes to healthcare teams.
• Improved patient outcomes by meticulously reviewing patient records to ensure appropriate care levels.
• Conducted training sessions for new nurses, enhancing team's review capabilities.
• Ensured timely patient discharges by coordinating with healthcare teams, optimizing bed availability.
• Assessed patient feedback to inform quality improvement initiatives.
• Facilitated compliance with federal and state regulations, maintaining high standards of healthcare delivery.
• Monitored patient care outcomes to identify trends and areas for improvement.
• Communicated with healthcare team members to plan, implement and enhance treatment strategies.
• Reported findings to quality departments and worked with team to devise corrective actions for deficiencies.
• Recorded details regarding therapies to keep patient charts updated.
• Leveraged feedback and process improvement opportunities to create safer and healthier environment and increase patient satisfaction.
• Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
• Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.

Oversaw case management operations across multiple facilities, ensuring seamless collaboration among clinical teams, physicians, and patients.
• Drove business development initiatives, enhancing contracting processes and expanding service offerings.
• Achieved improvement in patient care coordination, leading to increased satisfaction scores and reduced hospital readmission rates.

AAMCN certification obtained 2010