Utilization Review Nurse - Axxon Technologies Contractor for Accentra Health
(2026-01)
- Conducted comprehensive reviews of medical records to assess necessity of treatments and procedures.
- Collaborated with healthcare teams to develop and implement utilization management strategies.
- Evaluated clinical data to ensure compliance with established guidelines and protocols.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Performed prior authorization review of services requiring notification.
- InterQual Proficient
- Performed Prior Authorizations for DME, Home Health, Inpatient Medical Admissions, Therapy, Hospice
Post-Acute Rehabilitation - PRN - Ignite Medical Resorts - Crown Point, IN
(2025-10 - 2026-01)
Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Demonstrated respect, friendliness, and willingness to help wherever needed.
- Worked flexible hours across night, weekend, and holiday shifts.
- Organized and detail-oriented with a strong work ethic.
UTILIZATION MANAGMENT NURSE - ez URS - Richardson, TX
(2024-07 - 2025-08)
- Quality Assurance Nurse
- Applies clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care.
- Consults with physician advisors to ensure clinically appropriate determinations
- Facilitated interdisciplinary collaboration for the development and implementation of evidence-based practice guidelines, promoting consistency in patient care delivery.
- Mitigated potential legal issues related to improper admission or discharge decisions by consulting with physicians regarding complex cases that required further clarification.
- Implemented continuous improvement program for utilization review process, leading to better healthcare management.
- Evaluated patient histories, complaints, and current symptoms.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
UTILIZATION REVIEW NURSE - InterCare InterMed Cost Containment Services - Glendale, CA
(2022-10 - 2024-07)
- Utilization Review Nurse
- Review medical history, treatment plan and documentations to identify if medical necessity has been meet and ensure treatments are not over-utilized, safe and meet evidence-based guidelines
- Identifying prior treatments and validating the treatment plan and diagnosis
- Refers, coordinates and interacts with peer clinical reviewers and facilitates peer discussion during peer clinical reviewer processes
- Evaluates need for continued or alternative treatment plan with provider
- Maintains confidentiality and security in all aspects of performance
