Kathryn Manzoor
Manchester
Summary
Detail-oriented Licensed Practical Nurse (LPN) with 14+ years of healthcare experience spanning clinical care, utilization management, prior authorization, quality auditing, compliance, and regulatory review. Proven expertise in medical documentation review, policy interpretation, regulatory compliance, audit processes, data accuracy, and quality improvement. Highly skilled in healthcare administration workflows, insurance regulations, provider communication, and clinical documentation analysis. Strong background in remote healthcare operations, audit readiness, and cross-functional collaboration.
Overview
14
14
years of professional experience
1
1
year of post-secondary education
Work History
Quality Review Nurse Auditor
CareCentrix
Hartford
06.2021 - Current
- Conduct comprehensive quality and compliance audits of clinical prior authorization and utilization management determinations to ensure adherence to payer policies, CMS guidelines, NCQA standards, and regulatory requirements.
- Review complex medical documentation for accuracy, completeness, and compliance, ensuring alignment with healthcare regulations and reimbursement standards.
- Identify quality trends, data integrity issues, and documentation gaps, delivering actionable feedback and performance improvement guidance to clinical and administrative teams.
- Collaborate cross-functionally with operations, compliance, provider relations, and leadership teams to support audit readiness, regulatory reviews, and accreditation initiatives.
- Analyze authorization workflows to optimize efficiency, reduce errors, and enhance regulatory compliance.
- Maintain precise audit documentation and reporting within enterprise healthcare systems, supporting leadership dashboards and regulatory reporting.
Clinical Review Nurse
CareCentrix
Hartford
08.2018 - 07.2021
- Performed medical necessity and prior authorization reviews for DME, home health, and post-acute services, applying insurance carrier policies, CMS guidelines, and clinical criteria.
- Conducted detailed clinical documentation analysis to ensure accuracy, regulatory compliance, and reimbursement appropriateness.
- Communicated directly with provider offices, care coordinators, and payer representatives to resolve documentation gaps, clarify clinical data, and support timely approvals.
- Maintained high-volume, accuracy-driven workflows while meeting strict turnaround times and quality benchmarks.
- Developed advanced proficiency in payer systems, documentation standards, and healthcare administrative workflows.
Pediatric Home Care Nurse
Aveanna Healthcare
Plainville
12.2011 - 08.2018
- Delivered complex pediatric home nursing care while maintaining strict compliance with physician orders, regulatory standards, and agency documentation requirements.
- Provided extensive clinical documentation, care coordination, and interdisciplinary communication with physicians, therapists, and care teams.
- Educated families on care protocols, equipment use, and regulatory safety standards.
- Maintained detailed patient records to support billing, insurance compliance, and care continuity.
Education
LPN - Licensed Practical Nursing
Lincoln Technical Institute
New Britain, CT 03.2010 - 06.2011
Skills
- Regulatory Compliance Medical Documentation Review Insurance Guidelines Utilization Management Prior Authorization Quality Auditing CMS Regulations NCQA Standards InterQual / MCG Data Accuracy & Integrity Provider Communication Workflow Optimization Audit Reporting Healthcare Operations Process Improvement EMR Systems HIPAA Compliance Administrative Healthcare Support
Timeline
Quality Review Nurse Auditor
CareCentrix
06.2021 - Current
Clinical Review Nurse
CareCentrix
08.2018 - 07.2021
Pediatric Home Care Nurse
Aveanna Healthcare
12.2011 - 08.2018
LPN - Licensed Practical Nursing
Lincoln Technical Institute
03.2010 - 06.2011