Summary
Overview
Work History
Education
Skills
Timeline
Generic

Kendra O'Brien

Peabody,MA

Summary

Clinical Reviewer skilled in utilization review and regulatory compliance with a focus on patient advocacy. Engages in critical assessments to determine medical necessity and collaborates effectively with teams to optimize patient care. Enhances member satisfaction through dedicated communication and timely responses to needs.

Overview

2027
2027
years of professional experience

Work History

Utilization Reviewer, Inpatient R.N.

Point 32 Health
Canton, MA
11.2004 - 06.2026
  • Perform utilization review activities including concurrent and initial reviews utilizing CMR Interqual Criteria and MassHealth 130CMR 450.204.
  • Utilize decision making and critical thinking for review and determination of any medical necessary services
  • Refer any cases to Physician Reviewer when the request does not meet criteria.
  • Adhere to all regulatory mandates for turnaround times and NCQA
  • Collaborated with interdisciplinary teams to develop comprehensive patient care plans, contributing to improved health outcomes.
  • Retrieved clinical information from electronic medical records to ensure comprehensive patient data.
  • Participated in weekly meetings with case managers and team members for case collaboration and ongoing education.
  • Process single case agreements and reviews via department workflows.
  • Improved member satisfaction through effective communication, empathy, and prompt response to needs.
  • Provided documentation to MassHealth for long term care conversions.

Registered Nurse

New England Rehabilitation Hospital
Woburn, Massachusetts
  • Assessed, planned, implemented and evaluated nursing care for assigned patients.

Home Health Nurse

Visiting Nurse Community Health
Arlington , MA
  • Provided compassionate patient care in home settings across diverse populations.

Education

Bachelor of Science - Nursing

Salem State College
Salem, MA
12-1996

Skills

  • Utilization review
  • Clinical decision-making
  • Patient evaluation
  • Regulatory compliance
  • HIPAA compliance
  • Quality improvement
  • Quality control
  • Interdisciplinary teamwork
  • Time management
  • Teamwork
  • Patient advocacy

Timeline

Utilization Reviewer, Inpatient R.N.

Point 32 Health
11.2004 - 06.2026

Registered Nurse

New England Rehabilitation Hospital

Home Health Nurse

Visiting Nurse Community Health

Bachelor of Science - Nursing

Salem State College
Kendra O'Brien