Maria Stoebling
East Rutherford,NJ
Summary
Results-driven professional with a focus on optimizing utilization review processes. Achieved significant cost reductions through resource management while ensuring compliance and enhancing patient care outcomes.
Overview
4
4
years of professional experience
Work History
Utilization Review Nurse
Bergen New Bridge Medical Center
Paramus, NJ
12.2022 - Current
- Evaluated medical necessity for services and procedures to ensure compliance with regulations.
- Collaborated with multidisciplinary teams to develop and implement patient care plans.
- Utilized clinical guidelines and criteria to support decision-making in utilization review processes.
- Assessed and analyzed patient records to determine appropriate levels of care and service authorization.
- Educated staff on utilization review protocols and best practices to enhance operational efficiency.
- Led initiatives to streamline review processes, improving turnaround times for authorizations.
- Mentored junior nurses in effective utilization review techniques and regulatory requirements.
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Performed prior authorization review of services requiring notification.
- Served as a vital liaison between patients, healthcare providers, and insurance companies, fostering effective communication and coordination among all parties involved in the care process.
- Assisted discharge planning efforts through prompt identification of medically stable patients who were ready for transition to alternate levels of care.
Cardiac Stepdown Registered Nurse
Englewood Medical Center
Englewood, NJ
07.2022 - 10.2022
- Monitored vital signs and interpreted data to assess patient conditions in cardiac stepdown unit.
- Administered medications and treatments according to physician orders, ensuring patient safety and compliance.
- Collaborated with interdisciplinary teams to develop and implement individualized care plans for patients.
- Conducted regular assessments to identify changes in patient status, initiating timely interventions as needed.
- Handled a high volume of complex patients by prioritizing tasks and effectively delegating responsibilities to other team members, resulting in efficient patient care.
Education
Bachelor of Science - Nursing
Felician University
Lodi, NJ05-2022
Bachelor of Science - Biology
Felician University
Lodi, NJ05-2018
Skills
- Outpatient Care Prior Authorizations
- Continued Stay Reviews
- Insurance verification
- Communication
- Medicaid Knowledge
- Medicare Knowledge
- Commerical Insurance Knowledge
Timeline
Utilization Review Nurse
Bergen New Bridge Medical Center
12.2022 - Current
Cardiac Stepdown Registered Nurse
Englewood Medical Center
07.2022 - 10.2022
Bachelor of Science - Nursing
Felician University
Bachelor of Science - Biology
Felician University