Accomplished Registered Nurse with a proven track record at Aetna excelling in patient advocacy and clinical judgment. Demonstrated ability to apply state regulatory compliance and foster strong interpersonal relationships. Known for proactive problem-solving and culturally-sensitive care, significantly enhancing patient outcomes.
Currently working in appeals. Duties include independent medical necessity reviews and resolution, interpret clinical data, apply appropriate clinical guidelines and state specific regulations. Additional responsibilities include processing expedited appeals and voting on panel cases.