Melissa Marston
Warnerville
Summary
Dynamic medical professional with extensive experience in compliance standards review and chart auditing. Proficient in medical data collection, analysis, and authorization processes. Demonstrated ability to enhance operational efficiency through meticulous oversight and evaluation.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse
CDPHP
Albany
07.2025 - Current
- Conducted comprehensive reviews of medical documentation for authorization requests.
- Facilitated prompt review and determination of service requests.
- Collaborated with healthcare providers.
Health Care Surveyor
NYS OMIG
Albany
07.2024 - 03.2025
- Clinical MDS audits per NYS and Federal Policy guidelines
- Written preparation of audit documentation/determinations
- Communication with providers, facilities, and legal team
- Appeals assistance, exit conferences
- On site visits
Utilization Review Nurse
UHG/OPTUM
Kingston
03.2020 - 07.2024
- Clinical claims review, audits, prior authorization and reconsiderations of hospital admissions, DME, procedure, LTC, Millman, InterQual, DRG downgrades, RAC audits, and organization guidelines under Federal Code and Medicare benefit policy
- Collaboration with multidisciplinary teams including Medical Directors and administrative staff
- Documentation per state, federal, and company regulations
- Provided training for large groups
- Alternate SME
Nurse Case Manager
Fidelis Care
Latham
02.2019 - 03.2020
- Promotion of positive health outcomes through medical case management
- Collaboration with internal and external clients to facilitate compliance with state and company guidelines
- Utilization review
- Appeals processing
- Audits
Clinic Nurse
Albany Medical Center
Albany
01.2018 - 02.2019
- Daily triage/assessment of patient conditions
- Collaboration with multidisciplinary teams in all phases of patient care management
- Management of TAVR clinic
- Patient education, consents
- Documentation of patient management per protocol/facility/state requirements
Registered Nurse
Albany Medical Center
Albany
01.2017 - 01.2018
- Direct care and management of critical illnesses, injuries and surgical patients
- Collaboration with multidisciplinary teams
- Medication administration including vaso-actives and paralytics
- Monitoring systems including EEG, EVD, Massimo, Arterial lines, vents
- Complex dressing changes and maintenance
- Patient/family education and support.
Nursing Assistant
Albany Medical Center
Albany
12.2014 - 12.2016
- Assisted RN with direct patient care
- Facilitated communication between patient and assigned RN
- Expedited labs
Administrative Assistant to the Director
Niskayuna High School
Niskayuna
08.2011 - 12.2014
- Maintained calendar, mileage and expenses for Science Director
- Maintained attendance records, purchase orders, and budgets for faculty
- Student supervision
Paralegal/ Office Manager
Law Offices of Russell S. Burman, Esq.
Port Washington
08.2001 - 03.2007
- File management including research/preparation of legal documentation for tort litigation/courts
- Evidence preparation, court filings, court appearances
- Client communications, billing, banking, bookkeeping, supply maintenance, time sheets, payroll
Education
Bachelor of Science - Nursing
Capella University
Minneapolis, MN06-2026
Associate of Science - Nursing
Albany Memorial College of Nursing
Albany, NY12.2023
Bachelor of Arts - Political Science
Long Island University
Brookville, NY12.2023
Skills
- Critical thinking
- Patient assessment
- Clinical documentation
- Health policy knowledge
- Team collaboration
- Effective communication
- Utilization review
- Case management
- Healthcare regulations
- Medicare
- Clinical auditing
- Regulatory compliance
- Medicaid
- Multitasking capacity
- Professionalism
- Government Programs Understanding
- Negotiation skills
Certification
Registered Nurse, New York, 01/17-Present, #727065
Timeline
Utilization Review Nurse
CDPHP
07.2025 - Current
Health Care Surveyor
NYS OMIG
07.2024 - 03.2025
Utilization Review Nurse
UHG/OPTUM
03.2020 - 07.2024
Nurse Case Manager
Fidelis Care
02.2019 - 03.2020
Clinic Nurse
Albany Medical Center
01.2018 - 02.2019
Registered Nurse
Albany Medical Center
01.2017 - 01.2018
Nursing Assistant
Albany Medical Center
12.2014 - 12.2016
Administrative Assistant to the Director
Niskayuna High School
08.2011 - 12.2014
Paralegal/ Office Manager
Law Offices of Russell S. Burman, Esq.
08.2001 - 03.2007
Bachelor of Science - Nursing
Capella University
Associate of Science - Nursing
Albany Memorial College of Nursing
Bachelor of Arts - Political Science
Long Island University