Mary Moscoso
115 Chase Road, Egg Harbor Township ,NJ
Summary
Utilization Management Nurse Reviewer at Atlanticare Regional Medical Center with expertise in evaluating medical necessity and ensuring compliance with healthcare standards. Demonstrated success in interdisciplinary collaboration and critical thinking, leading to improved patient care through precise documentation and pre-certification processes. Focused on delivering excellence in clinical assessment and fostering team collaboration for optimal healthcare outcomes.
Overview
4
4
years of professional experience
1
1
Certification
Work History
Utilization Management Nurse Reviewer
Atlanticare Regional Medical Center
6550 Delilah Road, Egg Harbor Township , NJ
07.2021 - Current
- Conducts comprehensive reviews of patient records to ensure medical necessity, and compliance with MCG and healthcare standards.
- Utilizes evidence-based guidelines to support utilization review decisions and recommendations.
- Documents all utilization review activities, findings, and decisions in patient records and databases.
- Reviews clinical accuracy and completeness before submission to the payer.
- Performs pre-certification, concurrent, and retrospective reviews of inpatient services.
- Collaborates with physicians, advanced practice nurses, case managers, physical therapists, and the nursing team to facilitate timely discharge planning and transition of care.
Education
Bachelor of Science - Nursing
Central Philippine University
Iloilo City, Philippines03-1994
Skills
- Medical necessity evaluation
- Utilization review
- Clinical documentation
- Evidence-based guidelines
- Interdisciplinary collaboration
- Attention to detail
- Critical thinking
- Documentation
- Prior authorization
- Training staff
- Multitasking
- Professionalism
- Clinical assessment
- Psychiatric nursing
- Communication
- Team collaboration
- Task prioritization
- Healthcare regulations
Affiliations
- A dedicated wife and mother to my 2 sons. Band Mom for almost 7 years now.
Loves celebrating life events, attend parties, and conferences.
Travelling and visiting friends.
Cooking
Certification
- BLS certified
References
References available upon request.
Timeline
Utilization Management Nurse Reviewer
Atlanticare Regional Medical Center
07.2021 - Current
Bachelor of Science - Nursing
Central Philippine University
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