Jennifer Saunders
Sewell
Summary
Dedicated Registered Nurse with extensive clinical and ambulatory care experience, specializing in care coordination, triage, and patient advocacy. Proven ability to review clinical documentation, process prior authorizations, and apply medical necessity criteria to facilitate timely access to appropriate treatments. Skilled in collaborating with providers and interdisciplinary teams while delivering patient education and ensuring compliance with healthcare regulations. Detail-oriented and highly organized, equipped with strong analytical skills and a steadfast commitment to achieving quality outcomes. Eager to leverage clinical expertise in an RN role with Horizon Blue Cross Blue Shield of New Jersey.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Registered Nurse
Virtua Pulmonology
Sewell, NJ
11.2022 - Current
- Review and process prior authorizations for medications and treatments, ensuring alignment with medical necessity criteria.
- Prepare and support clinical appeals for denied services through detailed documentation review and evidence-based rationale.
- Collaborate with providers to obtain and clarify clinical documentation required for payer determinations.
- Communicate with insurance carriers regarding approvals, denials and required supporting information.
- Provide patient education regarding insurance decisions, treatment plans and medication access issues.
COVID Triage Nurse
Virtua Health
Pennsauken, NJ
01.2022 - 11.2022
- Performed telephonic clinical assessments using standardized protocols.
- Escalated cases based on clinical presentation and risk factors.
- Documented patient interactions to ensure continuity of care and compliance.
- Strengthened remote clinical decision-making and communication skills applicable to utilization review environments.
Field RN / Case Manager
Virtua Home Care
Mount Laurel, NJ
05.2021 - 01.2022
- Managed patient caseloads in the home setting, providing assessments, education and care coordination.
- Developed individualized care plans in collaboration with providers.
- Advocated for patient access to appropriate services and follow-up care.
Registered Nurse
Inspira Health Network
Woodbury, NJ
08.2019 - 02.2021
- Conducted patient assessments and coordinated care planning with interdisciplinary teams.
- Provided patient education on disease management and treatment adherence.
- Maintained accurate clinical documentation supporting care delivery and discharge planning.
Education
BSN -
Rowan University
01-2027
ADN - undefined
Our Lady of Lourdes School of Nursing
01-2019
Psychology
The Richard Stockton College of NJ
01-2006
Science
Camden County College
01-2003
Skills
- Prior Authorization Review
- Appeals & Grievance Processing
- Medical Necessity Determination
- Clinical Documentation Review
- Care Coordination
- Provider & Insurance Communication
- Utilization Management Support
- Patient Advocacy
- EMR Documentation (Epic)
Certification
- Registered Nurse (NJ)
- Basic Life Support (BLS)
Timeline
Registered Nurse
Virtua Pulmonology
11.2022 - Current
COVID Triage Nurse
Virtua Health
01.2022 - 11.2022
Field RN / Case Manager
Virtua Home Care
05.2021 - 01.2022
Registered Nurse
Inspira Health Network
08.2019 - 02.2021
ADN - undefined
Our Lady of Lourdes School of Nursing
Psychology
The Richard Stockton College of NJ
Science
Camden County College
BSN -
Rowan University