Highly adaptable and self-directed Registered Nurse with 7 years of comprehensive experience across diverse Med/Surg, Neurology, and high-acuity hospital settings. Proven expertise in chart review, protocol adherence, and resource management, including direct experience in a remote Telephone Triage role. Expert at leveraging Electronic Health Records (EHRs) and digital communication tools to ensure seamless documentation and timely patient disposition. Seeking a challenging Utilization Review role to apply clinical expertise, critical thinking, and advanced technological proficiency to ensure medical necessity and optimize resource utilization.
• Managed an average caseload of 5-7 complex patients while consistently performing thorough chart reviews to ensure documentation supported the patient's level of care (LOC).
• Collaborated daily with Case Management and Social Work to proactively execute effective discharge planning, significantly impacting patient Length of Stay (LOS) metrics.
• Mastered rapid integration into multiple EHR systems (Epic/Cerner), demonstrating high-level technical aptitude required for efficient chart abstraction and review.
• Provided high-quality, protocol-driven care for diverse patient populations, directly supporting appropriate resource utilization during hospitalization.
• Applied clinical guidelines and protocols to assess patient symptoms and determine the most medically appropriate disposition, ensuring cost-effective care.
• Functioned as a key point for risk management by accurately screening patients and preventing unnecessary emergency department (ED) visits.
• Utilized digital charting systems to meticulously document patient interactions, assessment findings, and recommended disposition in real-time, focusing on clear data for potential audits.
Utilization Review & Regulatory
Utilization Review principles
Application of Clinical Criteria (eg, InterQual/MCG)
Chart Abstraction & Data
Integrity
Risk Reduction & Quality
Assurance
Discharge Planning &
Continuum of Care
Technical & Remote Proficiency
Electronic Health Records
(EHR): Epic, Cerner
Telehealth platforms / Remote
Charting
Secure Messaging & VPN
usage
Microsoft Office Suite (Word, Excel)
Video Conferencing (Zoom, Teams)
Communication & Resource
Exceptional written documentation and verbal skills
Independent work and strong organizational skills
Interdisciplinary Team
Collaboration
Critical Thinking & Data
Analysis
Time Management & Deadline
Adherence