ELIZABETH MULLEN
Woodbury Heights
Summary
Board-certified Nurse Practitioner with extensive experience in utilization management, medical necessity review, prior authorizations, and evidence-based guideline application. Strong background in high-acuity pediatrics, emergency care, and complex case review. Highly skilled in ICD-10/9 and CPT coding, payer requirements, and interdisciplinary collaboration.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Certified Registered Nurse Practitioner
Elmer Pediatrics
11.2022 - Current
- Conduct medical necessity assessments and utilization review for diagnostic testing, medications, and treatment plans
- Prepare and submit prior authorizations and supporting documentation in compliance with payer guidelines
- Apply evidence-based clinical guidelines and payer criteria to ensure appropriate utilization of services
- Utilize ICD-10/9 and CPT coding to support accurate documentation and reimbursement
- Collaborate with physicians to optimize care plans and support utilization decisions
- Provide telemedicine and remote clinical services
- Precept nurse practitioners with focus on documentation accuracy and guideline compliance
Registered Nurse – Pediatric ICU
Children’s Hospital of Philadelphia
06.2019 - 09.2022
- Evaluated ongoing medical necessity for ICU-level care and advanced therapies
- Maintained compliant documentation supporting level-of-care decisions
- Collaborated with care management teams to support transitions of care
Registered Nurse – Emergency Department
Lehigh Valley Hospital
10.2017 - 06.2019
- Assessed patient acuity and appropriateness of emergency services and admissions
- Supported efficient patient throughput while ensuring documentation compliance
Education
Master of Science in Nursing -
Maryville University
01.2021
Bachelor of Science in Nursing - undefined
DeSales University
01.2017
Bachelor of Science - Rehabilitation & Human Services
Pennsylvania State University
01.2014
Skills
- Utilization & Medical Management
- Prior Authorization Review
- Medical Necessity Determination
- Evidence-Based Guidelines
- ICD-10/9 & CPT Coding
- Documentation Review
- Quality & Risk Management
- Appeals & Letters of Medical Necessity
- Case Management
- EPIC & Cerner
- Microsoft Office
Certification
- Pediatric Nurse Practitioner – Board Certified (PNP-BC)
- Certified Registered Nurse Practitioner (CRNP)
- Registered Nurse – PA & NJ
- Basic Life Support (BLS)
- Neonatal Resuscitation Program (NRP)
Timeline
Certified Registered Nurse Practitioner
Elmer Pediatrics
11.2022 - Current
Registered Nurse – Pediatric ICU
Children’s Hospital of Philadelphia
06.2019 - 09.2022
Registered Nurse – Emergency Department
Lehigh Valley Hospital
10.2017 - 06.2019
Bachelor of Science in Nursing - undefined
DeSales University
Bachelor of Science - Rehabilitation & Human Services
Pennsylvania State University
Master of Science in Nursing -
Maryville University