Mary Tuohey
Registered Nurse
Virginia Beach,Virginia
Summary
Accomplished Utilization Review Nurse Senior at Elevance Health, adept in reducing healthcare costs by efficiently utilizing resources and eliminating unnecessary treatments. Expert in InterQual Criteria and HIPAA Compliance, with a strong focus on compliance and industry best practices. Skilled in interpersonal communication, ensuring effective resolution facilitation and approvals.
Overview
13
13
years of professional experience
Work History
Utilization Review Nurse Senior
Elevance Health
05.2011 - Current
- 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.
- Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
Education
BSN - Nursing
Norfolk State University
Norfolk, VA05.2006
MBA -
Wester University
Kansas City, KS05.1985
Bachelor of Science - English/Chinese
United States Naval Academy
Annapolis, MD05.1981
Skills
- InterQual Criteria
- Documentation And Reporting
- Utilization review
- Records analysis
- Interpersonal and written communication
- Prior Authorization
- HIPAA Compliance
Affiliations
- Sigma Theta Tau Nursing Honor Society
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Utilization Review Nurse Senior
Elevance Health
05.2011 - Current
BSN - Nursing
Norfolk State University
MBA -
Wester University
Bachelor of Science - English/Chinese
United States Naval Academy
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