LISA ZALENKO, RN BSN

• Conduct clinical documentation reviews and utilization audits to assess medical necessity and compliance with payer, regulatory, and organizational standards.
• Apply MCG and InterQual criteria to support accurate level-of-care determinations and appropriate reimbursement outcomes.
• Identify documentation gaps and recommend corrective actions to improve audit defensibility, quality outcomes, and denial prevention.
• Collaborate with interdisciplinary and cross-functional teams to support standardized utilization review workflows and operational consistency.
• Support quality improvement initiatives through detailed clinical analysis and compliance-focused review processes.
• Utilize strong analytical and problem-solving skills to evaluate complex clinical cases in high-volume review environments.

• Managed complex neonatal cases with ventilator support and IV therapy, achieving optimal patient outcomes
• Collaborated with interdisciplinary teams to uphold clinical protocols, improving overall patient care quality
• Educated families on infant care and discharge planning, facilitating successful home transitions

• Coordinated care for 600+ oncology patients, optimizing service utilization and enhancing patient outcomes
• Collaborated with physicians in multidisciplinary tumor boards to formulate and implement tailored treatment strategies
• Conducted telephonic clinical assessments and triaged symptoms to inform timely patient care decisions
• Reviewed clinical documentation to support prior authorization and ensure medical necessity for treatment plans

• Coordinated multidisciplinary care for more than 300 pediatric oncology patients across complex treatment pathways and transitions of care.
• Supported pediatric population health goals through proactive care coordination, family education, and timely intervention planning.
• Conducted telephonic triage and symptom assessments to identify patient needs and facilitate access to appropriate services.
• Ensured compliance with authorization requirements, clinical pathways, and treatment protocols.
• Partnered with cross-functional clinical teams to support coordinated, patient-centered care delivery and operational efficiency.

•Delivered high-acuity critical care to pediatric patients in the PICU.
• Supported families through complex medical situations with education and emotional support.

• Applied evidence-based practice guidelines in patient care decisions, ensuring optimal treatment outcomes.
• Facilitated family understanding of care procedures and health management strategies, enhancing patient involvement in care decisions.

• Collaborated with multidisciplinary teams to develop tailored care plans for critically ill pediatric patients.
• Administered medications and treatments, ensuring optimal care for critically ill pediatric patients.
• Assisted in complex procedures, contributing to improved patient outcomes under supervision of physician staff.
• Applied evidence-based practice guidelines to inform decision making for optimal patient care.

• Provided direct care to pediatric patients with complex medical needs, effectively addressing unique health challenges.
• Responded to acute changes in vital signs, ensuring timely interventions for optimal patient outcomes.
• Created and assessed individualized patient care plans, actively monitoring progress to support recovery.

• Delivered high-acuity neonatal critical care in a fast-paced NICU environment, managing ventilator support, IV therapy, and complex pediatric cases.
• Collaborated with multidisciplinary teams to ensure adherence to evidence-based clinical protocols and quality standards.
• Supported care transitions and discharge planning through family education and coordinated care management strategies.
• Participated in process improvement initiatives focused on patient safety, care quality, and operational effectiveness.
• Maintained accurate clinical documentation and compliance with healthcare regulations and organizational policies.

• Monitored vital signs and assessed patient conditions in NICU, facilitating timely interventions and ensuring continuity of care.
• Coordinated interdisciplinary team efforts to enhance patient outcomes through comprehensive care strategies.
• Provided emotional support to families facing difficult decisions about their baby's care, fostering trust and understanding during critical moments.