Mary Brooke

Licensed Registered Nurse (BSN, RN) with extensive experience in utilization review, clinical auditing, and case management across hospice, acute care, and remote healthcare settings. Skilled in conducting prior authorization reviews, medical necessity determinations, and concurrent/retrospective chart audits in alignment with Medicare, Medicaid, and commercial payer guidelines. Adept at collaborating with physicians, interdisciplinary teams, and payers to ensure quality, cost-effective care while maintaining regulatory compliance. Proficient in EMR documentation, workflow optimization, and quality improvement initiatives that enhance efficiency and outcomes. Recognized for educating providers and staff on utilization processes, regulatory standards, and documentation best practices, leading to improved compliance and patient care.