Stephanie Friel
Network Medical Review (Examworks)
Delavan,WI
1
Certification
9
Years of experience
Skilled Registered Nurse specializing in workers' compensation clinical review and utilization review. Expertise in assessing complex medical cases nationwide, applying evidence-based guidelines and state regulations, and collaborating with interdisciplinary teams. Strong clinical judgment and regulatory compliance drive effective care and positive outcomes for injured employees.
Work History
Clinical Quality Assurance Coordinator
8 Years 9 Months- Conduct comprehensive clinical reviews of workers' compensation cases across all 50 states, evaluating medical necessity, treatment appropriateness, and clinical outcomes.
- Analyze complex medical records, diagnostic information, treatment plans, and clinical guidelines to support evidence-based workers' compensation determinations.
- Apply knowledge of state-specific workers' compensation regulations, utilization review requirements, and federal mandates to ensure compliant management of occupational injury cases.
- Collaborated with physicians and clinical reviewers to clarify medical findings and resolve discrepancies, ensuring accuracy and defensibility of clinical recommendations.
- Evaluated treatment plans and medical services against evidence-based guidelines and standards of care to identify opportunities for appropriate utilization of healthcare resources.
Registered Nurse
5 Months- Provided comprehensive nursing care to individuals with complex and profound disabilities, managing diverse medical needs and promoting optimal health and quality of life.
- Performed routine and comprehensive health assessments, recognizing changes in condition and promptly communicating clinical concerns to physicians.
- Implemented physician orders and collaborated with interdisciplinary care teams to ensure safe, effective, and individualized patient care.
- Maintained accurate and timely clinical documentation while serving as a liaison between patients, families, physicians, consultants, and case managers regarding patient status and care needs.
Education
Associate's Degree - Nursing
Skills
Compensation case management
Clinical Outcomes Evaluation
Medical Necessity Review
Occupational Injury Management
Multi-State Regulatory Compliance
Regulatory Compliance
State compliance
Treatment Plan Evaluation
Physician Collaboration
Clinical Documentation
Critical Thinking & Clinical Judgment
Certification
Registered Nurse (RN), Illinois - Active
Unrestricted License
Timeline
Clinical Quality Assurance Coordinator
Network Medical Review (Examworks)
12.2017 - CurrentRead More
Registered Nurse
Marklund at Mill Creek
07.2017 - 12.2017Read More
Waubonsee Community College
Associate's Degree from Nursing
Read More