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Experienced registered nurse since 2013 with expertise in utilization management, nurse consulting, school nursing, acute care nursing, rehabilitation nursing, and long-term care nursing. Seeking a rewarding and challenging nursing position to utilize conscientious and comprehensive nursing abilities. Possess a strong background in utilization management and nursing consultation, demonstrated by the development and implementation of effective care plans for optimal resource utilization and patient outcomes. Critical analysis and problem-solving skills contribute to collaborative team environments, enabling adaptability to evolving healthcare needs.

Utilization review nurse with extensive experience in reducing healthcare costs through strategic resource management and analytical expertise. Proficient in InterQual and MCG criteria, ensuring adherence to quality improvement and regulatory standards. Committed to enhancing patient care outcomes through effective collaboration with healthcare teams.

Results-driven Utilization Management Nurse Consultant with extensive experience in conducting utilization reviews and process improvement initiatives. Known for high productivity, attention to detail, and efficient task completion. Specialize in clinical guidelines interpretation, patient care coordination, and healthcare policy compliance. Excel in communication, decision-making, and problem-solving to enhance operational efficiency and patient outcomes. Demonstrated proficiency in critical analysis and problem-solving, contributing to collaborative team environments and adaptable to evolving healthcare needs.


  RN with 3 years of acute care experience in the medical-surgical unit and over 6 years of experience in utilization review, eager to leverage my clinical experience and skills to perform medical necessity reviews for inpatient admissions and outpatient services, utilizing evidence-based clinical guidelines, medical policy, and federal and state mandates in order to provide quality and cost-effective care.
  Active, Compact, Registered Nurse License in the State of Maryland.
  Bachelor's of Science in Nursing (BSN) graduate.
  Specialized in the healthcare utilization management industry, doing utilization review for major U.S. health plans and managed care models for over five years.
  Experience in various UM lines of business, such as Commercial Health Plan, Medicare, and Medicaid.
  Proficient knowledge of Milliman Care Guidelines and InterQual.
  Keen on the dynamics and logistics of working in a remote/hybrid setup, and highly efficient in Microsoft Office applications.


Diane Chapulis

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Utilization Management Nurse Consultant

Utilization Management Nurse Consultant

Education

Bachelor of Arts - Health Arts For Nurses

Diploma in Nursing - Nursing

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Utilization Management Nurse Consultant

Utilization Management Nurse Consultant

Bachelor of Arts - Health Arts For Nurses

Diploma in Nursing - Nursing

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