Nina Robinson
Abilene,Texas
Summary
With over 23 years of diverse experience in direct patient care, staff supervision, and department operations, highly qualified and experienced Registered Nurse. Skill set includes multitasking and prioritizing patient needs and daily assignments. Expertise in Case Management, Quality Management, Auditing, and Utilization Management specialties to ensure the highest level of care for patients.
Overview
20
20
years of professional experience
Work History
RN Denials Specialist (Contract)
Healthrise
07.2025 - Current
- Analyze clinical documentation and payer denials to develop comprehensive, evidence-based appeal letters.
- Partner with coding, billing, and case management teams to improve documentation integrity and reduce denial trends.
- Monitor payer patterns and educate clinical teams on denial prevention strategies and policy updates.
- Remote
Utilization Management Coordinator
Blue Cross Blue Shield
09.2024 - 07.2025
- Performed member or provider related administrative support
- Which may include benefit verification, authorization creation and management, claims inquiries and case documentation.
- Reviewed authorization requests for initial determination and/or triages for clinical review and resolution.
- Provided general support and coordination services for the department including but not limited to answering and responding to telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems.
- Assisted with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews.
- Remote
Quality Assurance Analyst - RN
Conifer Health Solutions
08.2023 - 09.2024
- Conducted post-service reviews using InterQual and other criteria to determine appeal viability.
- Prepared detailed, fact-based appeal narratives supporting medical necessity.
- Led documentation improvement initiatives to strengthen clinical defensibility.
- Performed QA audits to ensure compliance with regulatory and payer standards.
- Remote
RN Clinical Guide - Utilization Management
Devoted Health
04.2022 - 11.2022
- Reviewed clinical documentation for admission appropriateness and discharge readiness.
- Coordinated discharge planning, medical services, and chronic care coaching.
- Supported a patient-centered model by developing and managing personalized care plans.
- Remote
Concurrent Review Nurse - Utilization Management
UnitedHealth Group/WellMed
12.2019 - 04.2022
- Performed admission and concurrent reviews using MCG
- Documented and tracked utilization review via TruCare system and reported findings for QA.
- Promoted safe, effective care through medical necessity evaluations and compliance auditing.
- Remote
RN Case Manager
Blue Cross Blue Shield of Texas
02.2019 - 12.2019
- Managed individualized care plans addressing medical and psychosocial needs.
- Provided preventive care education, ensured home health coordination, and advocated for patient rights.
- Remote
Director of Nursing & Quality Management
Big Country Home Healthcare Services
Abilene, TX
01.2013 - 02.2019
- Directed clinical operations, quality assurance programs, and performance improvement initiatives.
- Ensured regulatory compliance, billing accuracy, and survey readiness.
- Led staff development programs and implemented standards of care.
- Improved patient satisfaction and operational efficiency through structured QA initiatives.
RN Field Nurse / Case Manager
Big Country Home Healthcare Services
Abilene, TX
01.2010 - 01.2013
- Delivered in-home nursing services and coordinated interdisciplinary care.
LVN Field Nurse / Assistant to DON
Big Country Home Healthcare Services
Abilene, TX
06.2006 - 01.2010
- Supported Director of Nursing in administrative and clinical capacities, overseeing care delivery.
Education
Master of Science - Nursing Administration
Walden University
Minneapolis, MN02-2024
Bachelor of Science - Nursing Practice
Galen College of Nursing
Louisville, KY07-2017
Skills
- Medical Necessity Review & Appeals
- InterQual & MCG Criteria
- Utilization & Case Management
- Quality Assurance & Performance Improvement
- Discharge Planning & Care Coordination
- Staff Leadership & Development
- EMR/EHR Systems (TruCare, nThrive, InterQual, VI, ACE)
- Regulatory Compliance (CMS, HIPAA)
- Direct patient care
- Patient and family advocacy
- Compassion and empathy
- Care planning
- Care plan development
- EMR / EHR
- Chronic disease management
- Data collection
- Case management
- Home health care
Timeline
RN Denials Specialist (Contract)
Healthrise
07.2025 - Current
Utilization Management Coordinator
Blue Cross Blue Shield
09.2024 - 07.2025
Quality Assurance Analyst - RN
Conifer Health Solutions
08.2023 - 09.2024
RN Clinical Guide - Utilization Management
Devoted Health
04.2022 - 11.2022
Concurrent Review Nurse - Utilization Management
UnitedHealth Group/WellMed
12.2019 - 04.2022
RN Case Manager
Blue Cross Blue Shield of Texas
02.2019 - 12.2019
Director of Nursing & Quality Management
Big Country Home Healthcare Services
01.2013 - 02.2019
RN Field Nurse / Case Manager
Big Country Home Healthcare Services
01.2010 - 01.2013
LVN Field Nurse / Assistant to DON
Big Country Home Healthcare Services
06.2006 - 01.2010
Bachelor of Science - Nursing Practice
Galen College of Nursing
Master of Science - Nursing Administration
Walden University