JAMIE BAGLEY
Everett,WA
Summary
Experienced Doctor of Nursing Practice and Board-Certified Psychiatric Mental Health Nurse Practitioner with expertise in behavioral health utilization review and medical necessity evaluation. Proficient in authorizations, renewals, appeal summaries, and regulatory documentation aligned with CMS and Medicaid standards. Demonstrated ability to optimize behavioral health documentation and collaborate effectively with interdisciplinary teams in telepsychiatry and managed care settings.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Psychiatric Mental Health Nurse Practitioner (PMHNP)
Optum Health
06.2024 - 09.2025
- Assessment, evaluation, diagnostic determination, on-going treatment, and clinical management, including medications/therapeutic orders and risk assessment for pediatric and adult patients.
- Conducted behavioral health medical necessity reviews and determined appropriate level of care for pediatric and adult populations.
- Completed documentation to support treatment authorizations, renewals, and concurrent reviews in compliance with payer criteria.
- Collaborated with utilization review and quality teams to ensure adherence to CMS, NCQA, and Joint Commission standards.
- Authored appeal summaries and justification letters for denied behavioral health claims.
- Maintained timely and accurate clinical documentation within EMR systems.
Psychiatric Mental Health Nurse Practitioner (PMHNP)
Thriveworks Counseling and Psychiatry
02.2024 - 06.2024
- Assessment, evaluation, diagnostic determination, on-going treatment, and clinical management, including medications/therapeutic orders and risk assessment for adult patients.
- Performed diagnostic and utilization-focused evaluations for adult behavioral health clients in a telepsychiatry setting.
- Documented clinical rationale for medical necessity and authorization renewals.
- Authored appeal summaries addressing payer denials to support coverage approvals.
- Partnered with administrative teams to streamline behavioral health documentation processes and improve authorization turnaround times.
Psychiatric Mental Health Nurse Practitioner (PMHNP)
Shodair Children’s Hospital
10.2020 - 12.2023
- Assessment, evaluation, diagnostic determination, on-going treatment, and clinical management, including medications/therapeutic orders, transfer authorization, risk assessment for pediatric patients.
- Conducted utilization review and appeal documentation for pediatric inpatient and outpatient psychiatric services.
- Evaluated medical necessity and collaborated with payers and internal quality teams to ensure compliance with Medicaid and CMS behavioral health standards.
- Prepared documentation and clinical summaries for appeals and authorization reviews.
- Ensured audit-ready EMR documentation in accordance with Joint Commission requirements.
PMHNP Resident
Ralph H. Johnson VA Medical Center
09.2019 - 09.2020
- Assessment, evaluation, diagnostic determination, on-going treatment, and clinical management, including medications/therapeutic orders and risk assessment for adult Veteran patients.
- Participated in behavioral health utilization review and documentation audits within VA regulatory guidelines.
- Supported interdisciplinary initiatives to improve consistency and accuracy of psychiatric documentation.
- Assisted in preparing medical necessity summaries and quality review documentation.
Education
Doctor of Nursing Practice (DNP) - Psychiatric Mental Health Nurse Practitioner
Montana State University
Bozeman, MT01.2019
Bachelor of Science in Nursing (BSN) - undefined
Montana Tech
Butte, MT01.2011
Skills
- Behavioral Health Utilization Review
- Appeals & Denials Management
- Medical Necessity, Concurrent & Retrospective Review
- Level of Care Evaluation
- Behavioral Health Documentation Review
- Quality Assurance
- CMS & Medicaid Compliance
- Payer Collaboration
- EMR Proficiency (Epic, Meditech, Advanced MD)
- Interdisciplinary Communication
- Audit Readiness
Certification
- PMHNP-BC (ANCC) Certification #2018089174
- Registered Nurse Primary State Licenses: MT, OR, & WA. RN Compact License (40+ states)
- Advanced Registered Nurse Practitioner: Montana #APRN-150502 & Washington #AP61500212
- DEA #MB8526278
Timeline
Psychiatric Mental Health Nurse Practitioner (PMHNP)
Optum Health
06.2024 - 09.2025
Psychiatric Mental Health Nurse Practitioner (PMHNP)
Thriveworks Counseling and Psychiatry
02.2024 - 06.2024
Psychiatric Mental Health Nurse Practitioner (PMHNP)
Shodair Children’s Hospital
10.2020 - 12.2023
PMHNP Resident
Ralph H. Johnson VA Medical Center
09.2019 - 09.2020
Bachelor of Science in Nursing (BSN) - undefined
Montana Tech
Doctor of Nursing Practice (DNP) - Psychiatric Mental Health Nurse Practitioner
Montana State University