MELANIE PROSPER
New Rochelle,NY
Summary
Nurse care management professional supporting high-volume member needs through utilization review, clinical documentation analysis, and person-centered service plan development. Coordinates with providers and care teams to guide 200+ members, improve access to services, and support timely, compliant care decisions using Medicare, Medicaid, and CMS guidelines.
Overview
1
1
Certification
4
4
years of professional experience
Work History
RN CHRONIC CARE MANAGER
VillageCare Max
New York, NY
10.2025
- Conduct utilization reviews of clinical documentation and service requests, documenting findings in GuidingCare and escalating pending requests to the Utilization Management team for further review.
- Develop and update person-centered service plans based on member assessments, healthcare needs, and applicable Medicare, Medicaid, and organizational guidelines.
- Manage a caseload of 200+ members by assessing care needs, coordinating with healthcare providers and interdisciplinary teams, and facilitating access to services to promote continuity of care.
URGENT CARE/MULTISPECIALTY NURSE
Summit Health
Westchester, NY
03.2023 - 10.2025
- Triaged and assessed high-volume patient encounters to prioritize care needs and facilitate timely interventions.
- Collaborated with providers and clinical teams to ensure seamless continuity of care for patients with acute and chronic conditions.
- Delivered patient education on treatment plans, medications, and disease prevention, enhancing patient adherence and health outcomes.
OCCUPATIONAL HEALTH NURSE
ATI Worksite Solutions
New York City
02.2024 - 09.2025
- Conduct clinical assessments and validate medical necessity for 700+ occupational health cases, ensuring documentation compliance with state/federal regulations.
- Coordinated referrals and aligned care with insurance coverage to facilitate timely interventions.
- Led workplace wellness education sessions to promote healthy lifestyle changes and mitigate risk factors.
HEALTH COORDINATOR
Maximus
New York, NY
09.2021 - 03.2023
- Informed 200+ members and families about care options and disease processes, enhancing engagement and addressing gaps in care.
- Facilitated access to necessary care by guiding members through available benefits and community resources.
Education
BACHELOR OF SCIENCE - NURSING
Mercy College
Bronx, NY05-2022
BACHELOR OF ARTS - ENGLISH LANGUAGE ARTS
Hunter College
New York, NY09-2014
Skills
- Medical Necessity, Utilization Review, Prior authorization, Healthcare Policy, Managed Care, Medicare Guidelines, Medicaid Guidelines, Case Review, CMS Compliance
- Utilization review
- Care coordination
- Clinical assessment
- Care plan development
Certification
- Registered Nurse New York
- Utilization Review: A Quality Perspective
- Utilization Management: Review Process Certification
Timeline
RN CHRONIC CARE MANAGER
VillageCare Max
10.2025
OCCUPATIONAL HEALTH NURSE
ATI Worksite Solutions
02.2024 - 09.2025
URGENT CARE/MULTISPECIALTY NURSE
Summit Health
03.2023 - 10.2025
HEALTH COORDINATOR
Maximus
09.2021 - 03.2023
BACHELOR OF SCIENCE - NURSING
Mercy College
BACHELOR OF ARTS - ENGLISH LANGUAGE ARTS
Hunter College