Shannon Bartlett
Windsor Locks,CT
Summary
Registered Nurse with 4+ years of clinical experience across pediatrics, home care, and inpatient behavioral health, complemented by 6+ years of healthcare litigation experience at Cigna. Experienced in utilization management functions including medical necessity review, prior authorization processing, eligibility verification, level-of-care assessment, discharge planning, and clinical documentation review. Proficient in applying InterQual and MCG criteria to support coverage determinations. Detail-oriented and compliance-focused professional committed to ensuring members receive appropriate care in alignment with regulatory and benefit guidelines.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Registered Nurse - Pediatrics
Enfield Pediatric Associates
Enfield, CT
07.2022 - Current
- Perform telephonic triage assessing patient acuity and determining appropriate level of care.
- Review clinical documentation supporting prior authorization and specialty service requests.
- Coordinate care with providers and families to ensure appropriate utilization of healthcare services.
- Apply evidence-based protocols and clinical judgment to guide treatment recommendations.
- Support transitions of care and reinforce discharge and follow-up plans.
- Identify patients requiring escalation or additional care coordination.
Registered Nurse - Home Care Admissions
Atrinity
Wallingford, CT
01.2022 - 07.2022
- Conducted comprehensive OASIS assessments to determine eligibility and medical necessity for home health services.
- Evaluated clinical documentation supporting admission and reimbursement decisions.
- Coordinated interdisciplinary care planning and monitored care outcomes.
- Facilitated safe transitions from hospital to home.
Registered Nurse - Behavioral Health (Home Care)
Elara Caring
Windsor, CT
08.2021 - 01.2022
- Provided skilled nursing services to behavioral health patients in the home setting.
- Monitored treatment effectiveness and collaborated with providers to adjust care plans.
- Identified quality-of-care concerns and escalated as appropriate.Provided skilled nursing services to adult behavioral health clients in a home care setting.
- Developed and documented individualized plans of care.
- Coordinated referrals to community-based services to support comprehensive care needs.
Registered Nurse - Behavioral Health (Inpatient)
Institute of Living
Hartford, CT
02.2021 - 08.2021
- Conducted psychiatric assessments and evaluated treatment needs across levels of care.
- Collaborated with multidisciplinary teams to develop individualized treatment plans.
- Participated in discharge planning ensuring continuity of behavioral health services.
- Assessed safety risk and appropriateness of inpatient treatment.
Senior Paralegal
Cigna
Bloomfield, CT
04.2015 - 01.2021
- Partnered with nurses and medical directors to review behavioral health coverage disputes and arbitration cases.
- Analyzed medical records and applied benefit plan language to support case evaluation and resolution.
- Interpreted healthcare policy and regulatory guidelines related to coverage determinations.
- Managed fraud, waste, and abuse investigations involving medical and behavioral health services.
Education
Health Coach Certification -
Institute of Integrative Nutrition
03-2026
Associate Degree - Nursing
Goodwin University
East Hartford, CT12-2019
Bachelor of Science - Legal Studies
Newbury College
Brookline, MA05-2006
Skills
- Medical Necessity Review
- InterQual & MCG Criteria
- Utilization Management
- Eligibility & Benefit Verification
- Level of Care Determination
- Discharge Planning
- Clinical Documentation Review
- Coverage Determination Support
- Policy Interpretation
- Regulatory Compliance
- Care Coordination
- EHR Documentation
- Microsoft Office
- Prior authorization
Certification
• Registered Nurse - Connecticut, Active, Unrestricted
Timeline
Registered Nurse - Pediatrics
Enfield Pediatric Associates
07.2022 - Current
Registered Nurse - Home Care Admissions
Atrinity
01.2022 - 07.2022
Registered Nurse - Behavioral Health (Home Care)
Elara Caring
08.2021 - 01.2022
Registered Nurse - Behavioral Health (Inpatient)
Institute of Living
02.2021 - 08.2021
Senior Paralegal
Cigna
04.2015 - 01.2021
Health Coach Certification -
Institute of Integrative Nutrition
Associate Degree - Nursing
Goodwin University
Bachelor of Science - Legal Studies
Newbury College