VICKI SCHMITS
Oscoda,MI
Summary
Dynamic Registered Nurse with over 30 years of clinical experience, including more than 7 years dedicated to utilization review in both in-person and remote settings. Strong command of prospective, concurrent, and retrospective reviews utilizing InterQual criteria to assess medical necessity and appropriate levels of care. Consistently achieves strict turnaround times and productivity standards while maintaining impeccable quality scores. Exceptional analytical, documentation, and communication skills, with a keen focus on payer guidelines and regulatory compliance.
Overview
2027
2027
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse (Remote Contract)
Walker Health
Southfield, MI
02.2023 - Current
- Conducted thorough inpatient reviews, both prospective and retrospective, to ensure compliance and quality across facilities nationwide.
- Evaluated InterQual criteria and exercised clinical judgment to assess appropriate level of care and medical necessity.
- Monitored adherence to state regulations and payer policies to support regulatory compliance.
- Communicate determinations to providers within mandated turnaround timeframes
- Escalate complex cases to Medical Director with clear clinical summaries
- Conducted thorough assessments to maintain 100% quality review scores, focusing on accuracy and timely completion of tasks.
- Consistently exceed productivity benchmarks in a high-volume environment
- Contracted to Blue Cross Blue Shield of Michigan
Utilization Review Nurse (Remote)
Insight Service Group
Danvers, MA
01.2018 - 2023
- Executed thorough evaluations of auto-related medical claims for insurance carriers.
- Evaluated medical necessity and causality to ensure compliance with established clinical guidelines.
- Engaged with physician reviewers to support thorough and precise case evaluations.
- Ensured adherence to regulatory and payer standards through comprehensive compliance management.
- Facilitated training and onboarding processes for new staff members.
Travel Nurse – ICU/PACU
Medical Solutions
01.2013 - 01.2018
- Delivered comprehensive perioperative and recovery care across diverse hospital environments, including trauma centers and rural facilities.
- Adapted quickly to new environments and workflows to maintain operational efficiency.
- Provided high-quality patient care by applying advanced clinical and critical thinking skills.
- Executed medication administration and treatment protocols with precision and adherence to established guidelines.
- Coordinated efforts with diverse teams to prioritize and implement patient-centered care strategies.
Registered Nurse (CCRN)
Munson Medical Center
Traverse City, MI
- Provided patient care in ICU, PACU, medical-surgical, and ambulatory settings
- Managed high-acuity patients requiring complex clinical assessment
- Collaborated with multidisciplinary teams to ensure optimal outcomes
Education
Associate Degree in Nursing (ADN) - Nursing
Northwestern Michigan College
Traverse City, MI05-1996
Bachelor of Arts - Journalism
Michigan State University
East LansingSkills
- Utilization Review Commercial
- InterQual Criteria
- Medical Necessity Determination
- Concurrent, Prospective & Retrospective Reviews
- Payer Guidelines
- Clinical Documentation Review
- Case Escalation to Medical Director
- Time Management & Productivity Metrics
- Electronic Medical Records Care Advance
- Provider Communication
- Independent Remote Work
Certification
- Registered Nurse – Michigan (Active, Unrestricted)
- Previously licensed in Washington, Vermont, and Connecticut
- Willing to obtain additional state licensure as required
Timeline
Utilization Review Nurse (Remote Contract)
Walker Health
02.2023 - Current
Utilization Review Nurse (Remote)
Insight Service Group
01.2018 - 2023
Travel Nurse – ICU/PACU
Medical Solutions
01.2013 - 01.2018
Registered Nurse (CCRN)
Munson Medical Center
Associate Degree in Nursing (ADN) - Nursing
Northwestern Michigan College
Bachelor of Arts - Journalism
Michigan State University
KEY ACHIEVEMENTS
- Maintained 100% quality audit scores in current role
- 7+ years of remote utilization review experience
- Consistently met or exceeded productivity and turnaround standards
- Strong expertise in InterQual criteria and payer-based decision making