
Experienced registered nurse with 10+ years in perioperative care, including operating room, burns/plastics, and endoscopy. Strong background in critical patient care and advocacy for diverse populations. Recently moved into utilization review, adept at conducting thorough case reviews using clinical criteria. Looking to leverage clinical experience and analytical skills in a challenging healthcare management role.
Utilization review methodologies Concurrent, prospective, and retrospective assessments Compliance with URAC and state regulations Contractual compliance knowledge Application of InterQual and MCG standards
EHR documentation expertise Leadership skills Supervisory experience Patient and caregiver education Adaptability