Summary
Overview
Work History
Education
Skills
Certification
References
Timeline
Generic

Melissa Dryden

Dacula,GA

Summary

Seasoned nursing professional with over 18 years of experience in many different areas offering proven clinical knowledge, natural interpersonal strengths and technical abilities. Knowledgeable about EMR charting, medication administration and interdisciplinary collaboration focused on optimizing patient care and support. Quality-focused and efficiency-driven leader.

Overview

12
12
years of professional experience
1
1
Certification

Work History

Utilization Review Nurse

Piedmont Healthcare
05.2022 - 08.2024
  • Performed 25-35 initial and concurrent reviews daily utilizing the electronic medical record and applying appropriate InterQual criteria to determine appropriate level of care and status
  • Worked denied cases by reviewing and submitting updated clinical information often resulting in overturned denials and increased revenue for the hospital.
  • Submitted necessary clinical documents to appropriate payers as per contractual obligations and guidelines.
  • Coached, provided feedback, and guided others on the team. Was often a point person for questions.
  • Applied critical thinking skills during case reviews, identifying potential risks or challenges before escalation.
  • Collaborated with physicians to develop appropriate care plans based on utilization review findings that were both medically necessary and cost effective.
  • Assisted in maintaining regulatory compliance by staying up-to-date on Medicare, Medicaid, and commercial insurance requirements for utilization review activities.
  • Provided accurate documentation of all utilization review findings, ensuring a clear audit trail for future reference or analysis.
  • Supervised and maintained all utilization review documentation through EPIC.
  • Enhanced payer relationships by maintaining professional and effective interactions during the denial resolution process.

UR Nurse Case Manager

Northside Hospital Gwinnett
09.2013 - 05.2022
  • Performed 20-25 initial and concurrent reviews daily utilizing the electronic medical record and applying appropriate InterQual criteria to determine appropriate level of care and status
  • Strong working knowledge of InterQual criteria and apply appropriately to each case
  • Send clinical to appropriate payers per contracts and guidelines
  • Work with minimal guidance; seeks guidance on only the most complex tasks
  • Coach, provide feedback and guide others
  • Enhances professional growth and development through participation in educational programs, current literature, in-service meetings and workshops
  • High performer, meeting and exceeding productivity objectives

RN Case Manager

Maine Medical Center
08.2012 - 08.2013
  • Provided excellent patient centered care and oversight with proven ability to communicate and negotiate the health care industry with professionalism and efficiency
  • Provided critical training and management of personnel
  • Provided effective quality Case Management oversight on all hospital units, successfully managing routine caseload of 15-25 cases for adult patients
  • Demonstrated a strong working knowledge of InterQual criteria
  • Conducted assessments and developed efficient, cost effective and safe discharge plans
  • Facilitated daily interdisciplinary care rounds consisting of physicians, nursing, therapy including PT/OT/ST, nutrition and spiritual care

Education

Bachelor of Science - Nursing

University of New Hampshire
Durham, NH
01.2002

Skills

  • InterQual Criteria
  • Documentation And Reporting
  • Utilization review
  • Records analysis
  • Clinical assessment
  • Interpersonal and written communication
  • Physician consultations
  • Attention to Detail
  • Compassionate and Caring

Certification

Georgia, RN201107

References

Can provide upon request

Timeline

Utilization Review Nurse

Piedmont Healthcare
05.2022 - 08.2024

UR Nurse Case Manager

Northside Hospital Gwinnett
09.2013 - 05.2022

RN Case Manager

Maine Medical Center
08.2012 - 08.2013

Bachelor of Science - Nursing

University of New Hampshire

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Melissa Dryden