Mackenzie Renee Waters BSN RN LNC CRC
Lynn,Massachusetts
Summary
Nurse Reviewer experienced in healthcare quality assessment, audits, and patient chart reviews. Improved process efficiency and contributed to positive health outcomes through strong analytical skills and compliance with care delivery standards. Motivated by challenges, demonstrating a strong work ethic, adaptability, and exceptional interpersonal skills.
Overview
1
1
Certification
28
28
years of professional experience
Work History
Nurse Reviewer Consultant
Beacon Review
06.2017 - 07.2026
- Trained in Capitation Adjustment Risk Assessment (CARA) HCC to evaluate medical diagnoses for critically ill patients using electronic medical records (EMR). Eight (8) years of experience in complicated specialty Oncology reviews and coding, including performing both prospective and retrospective reviews while continuing to stay informed and educated on the most up to date ICD-10 changes/coding additions and deletions for 2026 and staying current in required CEU continuing education training credits for AAPC certification. Worked remotely 100%.
- Reviewed medical records for 20 years with 98% accuracy, leveraging 10 years of direct patient care in adults, pediatrics, oncology, dialysis, medical surgical, and critical care ICU to enhance review quality.
- Reviewed Beacon Review clinical records for medical necessity
Registered Nurse Site Review Consultant
Medassurant/Inovalon
03.2008 - 10.2017
- Medical Record Reviewer March 2008 to October 2017 Per Diem
- HEDIS and HCC training in medical record reviews.
- Evaluated lab values, radiographic imaging, specialty consults, inpatient and outpatient encounters, cardiac tests, procedures, dialysis, surgical and post-op records in electronic medical records (EMR) to ensure accurate ICD-9/ICD-10 coding for Medicare/CMS patients, adhering to CMS standards and guidelines. Completed medical record reviews and submitted forms to insurance companies. Achieved 96% accuracy for completed reviews. Worked remotely 100%.
Medical Legal Investigator (Program manager IV)
Commonwealth of Massachusetts-Office of the Chief Medical Examiner
03.2013 - 10.2015
- Personally identified all five victims of the Boston Marathon Bombing, including the alleged bomber, and supported families throughout the identification process with sensitivity. Contributed to high-profile homicide investigations, including the Aaron Hernandez case. Participated in quarterly Massachusetts State Child Fatality meetings.
- Served at the Massachusetts Office of the Chief Medical Examiner, handling diverse cases including homicide, suicide, sexual assault, domestic violence, and child fatalities. Conducted forensic identifications of remains using dental and medical/radiological information, DNA technology, and Massachusetts State Crime Lab resources. Communicated directly with families of deceased and performed in-person photo forensic identifications. Conducted fieldwork at regional crematories for body viewing and cremation authorization, while reviewing death certificates for acceptable/reportable causes of death, trained to identify suspicious unattended deaths and signs of trauma or foul play. Attended quarterly Child Fatality meetings.
- Investigated medico-legal cases for Commonwealth medical examiner death review.
- Facilitated communication with law enforcement regarding death scene inquiries.
Nurse Case Manager/Lead Nurse Blue Health Coach Program/ Pharmaceutical Grant Pilot
Blue Cross Blue Shield of Massachusetts
09.2011 - 03.2013
- Medication Adherence Program
- Blue Health Coach program/Medication Adherence-Health Management Department September 2011 to March 2013
- Led grant pilot program funded through Express Scripts-light touch case management, engaging patients to resolve medication nonadherence and providing research-based alternatives to improve community compliance and support public health. Conducted telephonic nursing assessments and delivered interactive education in oncology, pharmacology, light-touch case management, complex case management, blood pressure, diabetes, cholesterol, asthma, medications, and healthcare/medical insurance procedures. Trained in motivational interviewing and interactive communication/active listening skills to enhance patient engagement.
Legal Nurse Consultant
Records Express LLC
01.2011 - 01.2013
- Legal Nurse Consulting-Pharmaceutical/Medical Malpractice Litigation
- Reviewed medical records for pharmaceutical litigation, compiled physician certificates, and organized data into spreadsheets for attorney analysis.
- Reviewed medical records for legal case chronology and consistency.
- Summarized treatment histories for attorney and claim support.
Pediatric Critical Care ICU (Pediatrics)
University of California San Francisco Hospital
01.2003 - 08.2007
Pediatric Oncology/Renal (Pediatrics)
Detroit Children's Hospital
01.2001 - 01.2003
Medical/Surgical (Adults)
University Of Michigan Hospital-Floor 6B
01.1999 - 01.2001
Education
Bachelor of Science in Nursing - Nursing, R.N.
University of Michigan, School of Nursing
Ann Arbor, Michigan 08.1995 - 05/1999
Legal Nurse Consultant Certification(LNC) - Nursing
California State University-East Bay
Hayward, CaliforniaSkills
- HCC risk adjustment
- ICD-10 coding
- EMR review
- CMS compliance
- Medical record review
- Utilization review
- Clinical documentation review
- Case management
- Legal nurse consulting
- Attention to detail
- Critical thinking
- Analytical reasoning
- Clinical judgment
- HIPAA compliance
- Healthcare regulations
- Clinical assessment
- Quality improvement
- Policy compliance
- Family advocacy
- EMR systems
- Case chronology
- Chart abstraction
- Medical coding
- Case review
- Record analysis
- Medical malpractice
- Medical documentation
- Team collaboration
- Decision making
- Adaptability
Certification
- Certified Risk Coder(CRC)-American Academy of Professional Coders, Passed AAPC certification November 2019, Expires October 31, 2026
- Legal Nurse Consultant Certificate-California State University-East Bay Continuing Education, Graduated/Passed June 2007, Never Expires
- Massachusetts Registered Nurse License
#RN2268955
ADVANCED TRAINING/INTERNSHIPS
- Pediatric Forensic Sexual Assault Nurse Examiner (PSANE) Training Course. Completed training course March 2009
- Adult Forensic Sexual Assault Nurse Examiner (SANE) Training Course. Completed training course January 2009
- Legal Nurse Consultant Internship-Washtenaw County, Michigan, Public Defender's Office. Summer 2008-Internship, one-on-one with Washtenaw Public Defender
Timeline
Nurse Reviewer Consultant
Beacon Review
06.2017 - 07.2026
Medical Legal Investigator (Program manager IV)
Commonwealth of Massachusetts-Office of the Chief Medical Examiner
03.2013 - 10.2015
Nurse Case Manager/Lead Nurse Blue Health Coach Program/ Pharmaceutical Grant Pilot
Blue Cross Blue Shield of Massachusetts
09.2011 - 03.2013
Legal Nurse Consultant
Records Express LLC
01.2011 - 01.2013
Registered Nurse Site Review Consultant
Medassurant/Inovalon
03.2008 - 10.2017
Pediatric Critical Care ICU (Pediatrics)
University of California San Francisco Hospital
01.2003 - 08.2007
Pediatric Oncology/Renal (Pediatrics)
Detroit Children's Hospital
01.2001 - 01.2003
Medical/Surgical (Adults)
University Of Michigan Hospital-Floor 6B
01.1999 - 01.2001
Bachelor of Science in Nursing - Nursing, R.N.
University of Michigan, School of Nursing
08.1995 - 05/1999
Legal Nurse Consultant Certification(LNC) - Nursing
California State University-East Bay