Melodie Shepherd

Executed peer reviews for disability and workers' compensation claims, maintaining high standards.
Conducted quality assurance reviews to ensure accuracy and consistency in evaluations.
Performed audits on peer reviewers to verify compliance and deliver constructive feedback.
Facilitated continuous improvement via regular feedback and performance metrics.

• Assessed medical guidelines, including ODG, ACOEM, and Interqual NYMTG, for service appropriateness.ess.
  Facilitated resolutions through case submissions for physician review on identified criteria failures.
  Conducted peer reviews on utilization to ensure compliance with established standards.
  Oversaw daily operations of LVNs and administrative staff to enhance team performance.
  Monitored timesheets, attendance logs, and call center metrics for operational efficiencies.
  Resolved customer complaints promptly to strengthen satisfaction and loyalty.
  Evaluated staff performance and implemented professional development plans.
  Completed audits of nursing staff to ensure alignment with URAC protocols.

• Executed comprehensive medical reviews, affirming necessity and appropriateness of clinical services.
  Reviewed medical guidelines in conjunction with benefit coverage to ensure compliance.
  Documented utilization review activities meticulously, aligning with regulatory standards.
  Assisted with case submissions for criterion failures, promoting swift resolutions and approvals.