Shari Smoorenburg
Rio Dell,CA
Summary
Nursing professional with over 12 years of direct care experience, specializing in utilization review. Advanced to lead role at HealthNet Federal Services, providing education and feedback on audits to clinical reviewers. Currently serving as a Utilization Clinical Reviewer at TriWest, with expertise in healthcare software such as Care Radius and InterQual. Proven track record in enhancing utilization management processes and improving operational efficiency.
Overview
16
16
years of professional experience
Work History
Utilization Clinical Reviewer
TriWest Healthcare Alliance
Phoenix, Arizona
03.2025 - Current
- Maintained up-to-date knowledge of clinical guidelines and policies.
- Reviewed clinical documentation for compliance with policy.
- Worked closely with physicians, nurses, and other healthcare professionals as needed.
- Interpreted medical literature relevant to the clinical review process.
- Maintained positive working relationship with fellow staff and management.
Utilization Review Nurse Lead
Health Net Federal Services LLC
Fortuna, CA
01.2024 - 12.2024
- Evaluated patient medical records to verify the suitability of requested services.
- Evaluated clinical documentation for accuracy and completeness in order to make decisions about coverage determinations
- Assisted other nurse reviewers with policy questions and maintained monthly audits for team.
- Collaborated with other leads and supervisors to share information with other reviewers regarding updates to TRICARE policies.
Utilization Management Nurse I
Eight Eleven LLC
Roseville, CA
09.2022 - 01.2024
- Assessed patient eligibility for services and benefits according to TRICARE insurance policies and guidelines.
- Maintained knowledge base on current coding practices, government regulations, payer requirements.
- Ensured compliance with organizational policies and procedures related to utilization management processes.
- Referred cases to secondary review for failure to meet policy criteria.
Pediatric RN
OMV Medical Inc
Wheatland, CA
02.2020 - 04.2022
- Pediatric RN responsible for phone triage, referrals and some patient care for Pediatric patients and filled in for Family Health RN frequently
- Worked closely with other healthcare professionals to provide superior medical care to all dependents at Beale AFB.
- Counseled patients and families to provide psychological, emotional and spiritual support.
Home Health RN
Eden Home Health
Elk Grove, CA
11.2019 - 01.2020
- Home health RN responsible for admitting patients to HH agency, assessing physical condition and diagnoses and formulating an appropriate care plan for the patients
- Completed OASIS charting for Medicare patients.
Utilization Review Nurse
EK Health Services
Rocklin, CA
05.2018 - 09.2019
- Healthcare Professional (HCP) responsible for Workers Compensation utilization review for a variety of clients within California
- Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
- Referred cases to secondary review for failure to meet Workers Comp criteria.
Staff RN
Santa Rosa Memorial Hospital
Santa Rosa, CA
04.2010 - 01.2018
- Responsible for all aspects of care for pediatric patients ages newborn to 18 at Community Hospital
- Responsible for patients with respiratory illness, post-surgical care, gastro illness or trauma
- Instructed patients, families and caregivers on diagnoses, chronic disease management and medication self-management.
Education
Associate Degree - Nursing
Santa Rosa Jr. College
Santa Rosa, CA12-2009
Clinical Medical Assistant - Healthcare
Empire College
Santa Rosa01-2005
Skills
- Excellent written/verbal communication skills
- Worked well independently and within a team, managing audits for my team
- 12 years of direct care nursing
- Knowledge of many medical software programs
- Superior customer service skills
- Provided training and audit feedback
- Managed ast minute urgent referrals for timeliness
Timeline
Utilization Clinical Reviewer
TriWest Healthcare Alliance
03.2025 - Current
Utilization Review Nurse Lead
Health Net Federal Services LLC
01.2024 - 12.2024
Utilization Management Nurse I
Eight Eleven LLC
09.2022 - 01.2024
Pediatric RN
OMV Medical Inc
02.2020 - 04.2022
Home Health RN
Eden Home Health
11.2019 - 01.2020
Utilization Review Nurse
EK Health Services
05.2018 - 09.2019
Staff RN
Santa Rosa Memorial Hospital
04.2010 - 01.2018
Associate Degree - Nursing
Santa Rosa Jr. College
Clinical Medical Assistant - Healthcare
Empire College