Nikki Schmidt

Registered Nurse with 13+ years of progressive healthcare experience specializing in clinical auditing, utilization management, prior authorization review, regulatory compliance, healthcare quality improvement, and performance monitoring. Proven expertise in clinical documentation review, CMS and NCQA standards, performance improvement initiatives, and healthcare operations. Experienced in evaluating complex clinical records, identifying compliance risks, supporting regulatory audits, and collaborating with interdisciplinary teams to improve quality outcomes.

MSN-Ed prepared nurse leader with strengths in clinical education, process improvement, staff development, and healthcare analytics.

Performance Monitor Specialist (Clinical Auditor), RN - Centene Corporation / Superior Health Plan - San Antonio, Texas

(2022-07)

• Review 150+ clinical records monthly while maintaining 98%+ IRR compliance and meeting all productivity targets. Conduct comprehensive clinical audits and documentation reviews to evaluate compliance with organizational, state, CMS, and NCQA performance standards.
• Analyze clinical records, health assessments, interventions, and care management documentation to identify compliance trends and performance improvement opportunities.
• Collaborate with operational leaders and interdisciplinary teams to strengthen quality assurance processes and regulatory adherence.
• Participate in the development, validation, and ongoing refinement of clinical review tools to ensure accurate measurement of performance standards.
• Review policies, procedures, training materials, program descriptions, and contractual requirements to assess alignment with regulatory and organizational expectations.
• Escalate compliance concerns and documentation deficiencies to appropriate stakeholders for corrective action.
• Support preparation and readiness activities for state, CMS, and NCQA audits through targeted record reviews and compliance monitoring.
• Present audit findings and recommendations to leadership and operational teams to drive quality improvement initiatives.
• Consistently meet or exceed established productivity and inter-rater reliability (IRR) standards while maintaining high audit accuracy.
• Utilize strong analytical and clinical judgment skills to evaluate healthcare delivery and documentation practices.

Prior Authorization Nurse, LVN/RN - Centene Corporation / Superior Health Plan - San Antonio, Texas

(2013-04 - 2022-07)

• Performed medical necessity reviews utilizing evidence-based clinical criteria and regulatory guidelines to determine appropriateness of requested healthcare services.
• Evaluated authorization requests across multiple levels of care while ensuring compliance with organizational and regulatory requirements.
• Collaborated with providers, care teams, and medical directors to facilitate timely authorization decisions and continuity of care.
• Coordinated discharge planning and transitions of care to promote appropriate utilization of healthcare resources.
• Maintained accurate clinical documentation within health management systems while ensuring compliance with regulatory standards.
• Educated providers and internal stakeholders regarding utilization management processes and authorization requirements.
• Identified opportunities to streamline workflows and improve authorization review processes.
• Served in a Team Lead capacity by assigning work, mentoring staff, and supporting departmental operations. Trained and onboarded 15+ new staff members contributing to improved departmental productivity and quality outcomes.
• Recognized for leadership, clinical expertise, and ability to support operational efficiency in a high-volume environment.

Clinical Nurse Specialist, LVN - Kinetic Concepts, Inc. - San Antonio, Texas

(2009-07 - 2013-04)

• Conducted telephonic clinical assessments to monitor wound progression and treatment effectiveness for patients receiving Negative Pressure Wound Therapy (Wound VAC).
• Evaluated ongoing medical necessity and insurance coverage requirements to support authorization approvals.
• Collaborated with physicians, caregivers, and interdisciplinary healthcare teams to address barriers to wound healing.
• Identified candidates appropriate for advanced wound care therapies.
• Developed and implemented workflow improvements that were adopted across the department.
• Successfully managed multiple territories and provider relationships while maintaining high service standards.

Pre-Operative Nurse, LVN - The Center for Special Surgery - San Antonio, Texas

(2008-04 - 2009-07)

• Performed comprehensive pre-operative assessments for pediatric, adult, and geriatric surgical patients.
• Assessed physical, emotional, and psychosocial needs while ensuring patient readiness for surgery.
• Administered medications, initiated IV therapy, and prepared patients for operative procedures.
• Collaborated with physicians and anesthesia providers to support safe surgical outcomes.
• Managed patient flow in a high-volume ambulatory surgery environment.
• Served on the Infection Control Committee and participated in surveillance, analysis, and reporting of healthcare-associated infections.

Unit/Medication Nurse, LVN - Laurel Ridge Treatment Center - San Antonio, Texas

(2007-02 - 2009-07)

• Provided nursing care for pediatric, adult, and geriatric behavioral health patients.
• Administered medications and therapeutic treatments while monitoring patient response and progress.
• Collaborated with physicians, therapists, and multidisciplinary teams to support individualized treatment plans.
• Maintained a safe therapeutic environment for patients experiencing acute mental health challenges.
• Assisted in launching the organization's outpatient Electroconvulsive Therapy (ECT) Program.
• Trained and mentored newly hired nursing staff.

Charge Nurse, LVN - Riverview Nursing & Rehabilitation - Boerne, Texas

(2006-11 - 2007-02)

• Directed daily clinical operations and supervised Certified Nursing Assistants and Medication Aides.
• Delivered direct patient care while ensuring compliance with state and organizational standards.
• Developed and maintained care plans, clinical documentation, and regulatory records.
• Assisted with staffing, scheduling, hiring activities, and departmental leadership responsibilities.
• Served as Interim Assistant Director of Nursing until permanent leadership was appointed.

Staff Nurse, LVN - Boerne Acute Care Center - Boerne, Texas

(2006-08 - 2006-11)

• Performed patient assessments, medication administration, diagnostic testing, and clinical documentation.
• Assisted physicians with examinations and minor procedures.
• Coordinated outpatient testing and specialty referrals.
• Supervised medical assistants and supported clinic operations.
• Organized and implemented community flu vaccination clinics.

Master of Science in Nursing Education - Nursing Education - Galen College of Nursing (2024-04)

Bachelor of Science in Nursing - Nursing - Galen College of Nursing (2023-12)

Associate Degree in Nursing - Nursing - Galen College of Nursing (2021-12)

Licensed Practical Nursing Program - Nursing - Schreiner University (2006-05)