
Accomplished Utilization Review Nurse with a proven track record at Highmark Health, adept in InterQual criteria and effective communication. Expert in conducting in-depth clinical reviews and coordinating patient care plans, ensuring HIPAA compliance and enhancing healthcare quality. Demonstrated ability in problem-solving and critical thinking, significantly improving patient outcomes and care coordination efficiency.
Work remotely performing inpatient clinical reviews using Interqual for par and non par hospitals to establish medical necessity. Collaboration with Medical Director for denials, length of stay and discharge planning.
Performed clinical reviews using Interqual to establish medical necessity. Documentation and transmission of clinical data to insurance companies to ensure authorization. Discharge assessment, planning and implementation for up to 30 cases per day.
Planned, organized and directed care to the homebound patient. Monitored and educated on disease process. Provided community health education and resources to meet the needs of patients and their families.
Planned, organized and directed care to the homebound patient. Monitored and educated on disease process. Provided community health education and resources to meet the needs of the patient and their families. Direct supervision of CNAs. Preceptor for new nursing staff. Relief manager.
Promoted and restored patient health by completing the nursing process. Collaborated with multidisciplinary team members. Provided physical and psychological support to patients and their families. Supervision of assigned team members.