JENNIFER OGROSKY
Pittsburgh,PA
Summary
Utilization Management Nurse adept at evaluating medical necessity and advocating for patient care through critical thinking and interdisciplinary collaboration. Proven track record in maintaining precise documentation and enhancing patient outcomes by implementing effective care plans. Skilled in utilization review and committed to upholding patient confidentiality.
Overview
4
4
years of professional experience
1
1
Certification
Work History
Nurse Consultant
Aetna
151 Farmington Avenue, Hartford, Ct
11.2025 - 04.2026
- Evaluated patient care strategies to enhance quality and compliance with healthcare regulations.
- Provided expert consultation on medical policies, ensuring alignment with industry standards and best practices.
- Collaborated with interdisciplinary teams to develop comprehensive care plans for diverse patient populations.
- Utilized advanced electronic health record systems to maintain accurate documentation of patient care activities.
Utilization Management Nurse
Wexford Health Sources Inc
Pittsburgh, PA
10.2022 - 08.2025
- Ensured accurate coding of diagnoses and treatments provided according to accepted industry standards.
- Performed concurrent reviews by analyzing medical records in order to determine if services are medically necessary according to established criteria.
- Maintained detailed documentation regarding all utilization management activities.
- Managed time efficiently while balancing multiple priorities simultaneously.
- Consulted and coordinated with health care team members to assess and evaluate patient care plans.
- Advised providers on clinical practice guidelines and standards of care related to the utilization review process.
- Utilized a variety of software applications such as Outlook, Excel Spreadsheet, MCG Health, Optum Encoder Pro, InterQual.
- Collected relevant diagnoses and plans of care by querying clinical staff attending to patients.
Registered Nurse, Medical-Surgical Unit
St. Clair Hospital
Pittsburgh, PA
07.2022 - 10.2022
- Administered medications and treatments as directed and as appropriate for patient's medical care in collaboration with multi-disciplinary team.
- Assessed and prepared patients for procedures, performing initial and ongoing patient assessments.
- Monitored and managed various treatment and care interventions.
- Collected lab specimens, ordering and interpreting diagnostic tests and lab results.
- Observed patient's heart rate, blood pressure and respiration for signs of distress.
- Recorded patient condition, vital signs, recovery progress and medication side effects.
- Maintained thorough, accurate and confidential documentation in electronic medical records.
- Advocated for patients by supporting and respecting basic rights, values and beliefs.
Health Outreach Nurse
Baldwin Whitehall School District
Pittsburgh, PA
11.2021 - 07.2022
- Evaluated students with health concerns or injuries to develop plan of care or provide reference to appropriate healthcare providers.
- Coordinated with families, school personnel and healthcare professionals on behalf of students to advocate for healthcare needs and provide medical information to appropriate parties.
- Charted changes in patient conditions and discussed concerns with supervising healthcare provider.
- Addressed patient care needs, collected vitals, dressed wounds and managed catheters.
- Implemented normal growth and development screenings to identify health problems.
- Administered and supervised administration of prescription medication to students.
- Interacted effectively by email, phone and in person with students, parents and staff members.
Education
Diploma - Nursing
West Penn Hospital School of Nursing
05-2021
Associate of Applied Science - undefined
Clarion University
PA05-2021
Skills
- Critical Thinking
- Clinical assessment
- Utilization review
- Documentation and reporting
- Patient confidentiality
- Interdisciplinary collaboration
- Medical necessity evaluation
- Outpatient care
Certification
Nurse Licensure Compact (NLS)
Timeline
Nurse Consultant
Aetna
11.2025 - 04.2026
Utilization Management Nurse
Wexford Health Sources Inc
10.2022 - 08.2025
Registered Nurse, Medical-Surgical Unit
St. Clair Hospital
07.2022 - 10.2022
Health Outreach Nurse
Baldwin Whitehall School District
11.2021 - 07.2022
Associate of Applied Science - undefined
Clarion University
Diploma - Nursing
West Penn Hospital School of Nursing