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  An experienced RN and holds a BSN degree with extensive experience in case management, HEDIS quality assurance, insurance reviews, workers' compensation.
  Excellent experience in handling Disease Management programs for Commercial, Medicare Advantage, and Medicaid members with promotion of value-added services programs benefits.
  Expertise in performing quality chart review for quality issues for both Commercial, Medicare and Medicaid members and assisting with HEDIS quality measurement collection and reporting goal gaps.
  Experienced in Utilization Review, using InterQual and Milliman Care Guidelines/MCG for clinical reviews.
  Telephonic discharge planning, utilization review, telephonic guidance, chronic disease management, and wellness health education.

Compassionate Registered Nurse known for high productivity and efficient task completion. Skilled in patient assessment, and medication management. Excel at communication, teamwork, and empathy, ensuring optimal patient care and positive outcomes.

 To obtain a position as a Registered Nurse  Current registration with the CRNA (Reg:133607). Diploma in Nursing with over 15 years of work experience as a Registered Nurse (as a medical ICU, Medical ward, cardiac thoracic ICU, ortho and surgical unit nurse). 

Knowledgeable Shift Manager proficient in scheduling, money handling and team management. Successful at overseeing all areas of operations. Makes adjustments to scheduling and task prioritization to keep assignments and projects on schedule.
Compassionate Registered Nurse known for high productivity and efficient task completion. Skilled in patient assessment, emergency response, and medication administration. Excel at communication, teamwork, and empathy, ensuring optimal patient care and positive outcomes.

Knowledgeable Charge Nurse with excellent conflict resolution and problem-solving abilities demonstrated across 28-year career history. Keeps units running at peak efficiency, quality and performance. Excellent communication and coordination skills.

Detail-oriented Registered Nurse with 3+ years of acute-care and wound-care experience, holding a BSN and active California RN license. Expert in reviewing clinical documentation against payer guidelines to secure timely authorizations and minimize denials. Skilled at conducting chart audits in Epic/Cerner, collaborating with multidisciplinary teams to close documentation gaps, and generating data-driven utilization reports. Dedicated to optimizing care pathways, reducing length-of-stay variances, and improving reimbursement outcomes.

Gayle Carter

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RN

REGISTERED NURSE QA SPECIALIST, ICD 10 CODING

RN UTILIZATION MANAGEMENT

REGISTERED NURSE

REGISTERED NURSE

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Associate's Degree - Registered Nurse

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RN

REGISTERED NURSE QA SPECIALIST, ICD 10 CODING

RN UTILIZATION MANAGEMENT

REGISTERED NURSE

REGISTERED NURSE

Associate's Degree - Registered Nurse

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