Roselyn Schoen
Baton Rouge,LA
Summary
Experienced Utilization Review Nurse with expertise in medical necessity assessment, InterQual and MCG criteria, prior authorization, and EMR documentation. Known for supporting compliant coverage decisions, coordinating with physicians and payers, and promoting safe, timely care transitions.
Overview
21
21
years of professional experience
Work History
Utilization Review Nurse
Baton Rouge General Hospital
Baton Rouge, Louisiana
12.2025 - Current
- Reviewed admissions for medical necessity at Baton Rouge General Hospital.
- Applied InterQual and MCG guidelines for utilization decisions.
- Coordinated with physicians on concurrent review and discharge planning.
- Communicated with payers regarding coverage, precertification, and continued stay review.
- Tracked patient status for observation, inpatient, and transfer reviews.
- Educated care teams on utilization policies and documentation requirements.
- Collaborated with case management to support safe discharge transitions.
- Assessed patient medical records to determine the appropriateness of requested services and procedures.
- Served as a resource for staff members seeking guidance on utilization review matters.
- Evaluated clinical documentation for accuracy and completeness in order to make decisions about coverage determinations.
- Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
- Conducted reviews of inpatient utilization for compliance with admission criteria and concurrent review requirements.
- Monitored pre-authorization requests to ensure that all necessary information was received prior to approval or denial of services.
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
- Developed case management plans based on individual patient needs and eligibility criteria.
- Participated in provider meetings to discuss cases involving complex medical conditions or difficult authorization decisions.
- Collaborated with staff members in group meetings to identify issues and find cost-effective solutions.
- Submitted cases for secondary review to ensure accurate assessments of medical necessity. for failure to meet criteria.
- Utilized evidence-based guidelines to support utilization review decisions and recommendations.
- Ensured compliance with federal, state, and accreditation requirements related to utilization management.
- Documented all utilization review activities, findings, and decisions in patient records and databases.
- Collaborated with case managers to facilitate timely discharge planning and transition of care.
- Conducted comprehensive reviews of patient records to ensure medical necessity and compliance with healthcare standards.
- Performed pre-certification, concurrent, and retrospective reviews of inpatient and outpatient services.
Operating Room Registered Nurse
Baton Rouge General
Baton Rouge, LA
12.2006 - 12.2025
- Monitored patient status before, during, and after operative procedures.
- Assisted surgeons and anesthesia staff with safe patient positioning and transfers.
- Provided intraoperative care, including tissue retraction, suturing, and application of dressings.
- Aided during surgeries and coordinated supply management with surgical team to ensure seamless operation.
- Collaborated with surgeons, anesthesiologists and other healthcare professionals to provide optimal care for patients.
- Collaborated with operating room staff to support efficient surgical workflow.
- Prepared operating room for surgical procedures and upheld sterile field standards.
- Maintained a sterile environment in the operating room by adhering to aseptic techniques.
- Assisted surgical team in donning sterile gowns, gloves, and masks to maintain a sterile environment.
- Verified instrument counts, specimens, and implants according to hospital protocols.
- Managed instrumentation during surgical cases, ensuring proper functioning of equipment at all times.
- Assisted physicians with intraoperative procedures including specimen collection and tissue manipulation.
- Educated patients and families on pre-operative preparation and post-operative recovery to promote understanding and compliance.
- Educated patients and families on medical and surgical procedures, medication regimens, and pain management.
- Provided pre-operative and post-operative care for patients undergoing various surgical procedures.
- Documented perioperative care in electronic medical records and surgical charts.
- Documented all operative procedures and patient interactions in electronic medical records with attention to detail.
- Maintained accurate documentation of patient's medical record throughout the perioperative process.
- Utilized electronic health records to document patient care accurately and comprehensively.
- Assessed patient condition, vital signs and lab values to ensure safety during surgery.
- Initiated emergency resuscitative measures when indicated in the event of complications or unexpected outcomes.
- Implemented infection control protocols to prevent postoperative infections.
- Minimized infections using ChloraPrep, Mueller, and Snowden-Pencer laparoscopic instruments and infection prevention products.
- Participated in quality improvement initiatives to enhance patient outcomes in the OR.
- Utilized effective communication strategies when interacting with family members or other health team members.
- Acted as a liaison between the surgical team and the patient's family, providing updates and support during procedures.
- Conducted inventory checks and ordered supplies to maintain adequate stock for surgical procedures.
- Managed laboratory specimens by ensuring proper handling and storage protocols were followed. and inspected containers for correct packaging and labeling.
- Ensured appropriate positioning of patients on operating table prior to surgery.
- Advocated for patient needs and preferences throughout the surgical process to ensure patient-centered care.
- Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
- Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
Nurse Intern
Baton Rouge General Hospital
Baton Rouge, Louisiana
05.2006 - 12.2006
- Provided essential nursing care by monitoring vital signs, collecting laboratory specimens, and performing dressing changes to support patient recovery.
- Conducted physical assessments of patients including measurements of height, weight, temperature, pulse rate, and blood pressure.
- Performed sterile procedures such as wound care dressing changes.
- Adhered to infection control protocols and safety guidelines across various hospital units.
- Assisted nurses with patient care and unit activities to enhance overall patient comfort and safety.
- Relay patient needs to nurses, aides, and care team to ensure timely and effective care.
- Assisted physicians during examinations using correct terminology to communicate patient care matters.
- Responded quickly and efficiently to emergent situations while maintaining a calm demeanor under pressure.
Education
Bachelor of Science - Nursing
Southeastern University Louisiana
Hammond, LA12-2006
Skills
- Utilization review
- Medical necessity
- InterQual criteria
- MCG guidelines
- Clinical documentation
- Clinical documentation
- EMR documentation
- Clinical documentation
Timeline
Utilization Review Nurse
Baton Rouge General Hospital
12.2025 - Current
Operating Room Registered Nurse
Baton Rouge General
12.2006 - 12.2025
Nurse Intern
Baton Rouge General Hospital
05.2006 - 12.2006
Bachelor of Science - Nursing
Southeastern University Louisiana