Tara Peace

To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.

Utilization Review Registered Nurse - Centene, Superior Health Services - Telecommute

(2023-03)

• Analyze health care needs to determine a patient's treatment plans.
• Perform initial and concurrent review of inpatient cases applying evidenced-based criteria (i.e. MCG / Interqual criteria)
• Discuss cases with facility healthcare professionals to obtain plans-of-care
• Collaborate with Medical Directors performing utilization management
• Participation in discussions with the Clinical Services team to improve the progression of care to the most appropriate level
• Consult with the Medical Director, as needed, for complex cases and make appropriate referrals to downstream partners
• Apply clinical expertise when discussing case with internal and external Case Managers and Physicians
• Identify delays in care or services and manage with Medical director
• Follow all Standard Operating Procedures in end to end management of cases
• Obtain clinical information to assess and expedite alternate levels of care
• Facilitate timely and appropriate care and effective discharge planning
• Maintain compliance with Federal, State and accreditation

Utilization Review Registered Nurse - Cigna - Telecommute

(2016-09 - 2023-03)

• Perform initial and concurrent review of inpatient cases applying evidenced-based MCG criteria
• Discuss cases with facility healthcare professionals to obtain plans-of-care
• Participation in discussions with the clinical services team to improve the progression of care to the most appropriate level
• Consult with the Medical Director, as needed, for complex cases and make appropriate referrals to downstream partners
• Apply clinical expertise when discussing case with internal and external case managers and physicians
• Identify delays in care or services and manage with aligned Medical Director
• Follow all standard operating procedures in end-to-end management of cases
• Obtain clinical information to assess and expedite alternate levels of care
• Facilitate timely and appropriate care and effective discharge planning
• Maintain compliance with federal, state and accreditation organizations
• Identify opportunities for improved communication or processes
• Participate in audit activities and meetings.

Utilization Review Registered Nurse - Emblem Health - Telecommute

(2012-09 - 2016-08)

• Perform initial and concurrent review of inpatient cases applying evidenced-based Interqual criteria
• Discuss cases with facility healthcare professionals to obtain plans-of-care
• Collaborate with Medical Directors performing utilization management
• Participation in discussions with the clinical services team to improve the progression of care to the most appropriate level
• Consult with the Medical Director, as needed, for complex cases and make appropriate referrals to downstream partners
• Apply clinical expertise when discussing case with internal and external Case Managers and Physicians
• Identify delays in care or services and manage with aligned Medical Director
• Follow all standard operating procedures in end-to-end management of cases
• Obtain clinical information to assess and expedite alternate levels of care
• Facilitate timely and appropriate care and effective discharge planning
• Maintain compliance with Federal, State and accreditation organizations
• Identify opportunities for improved communication or processes
• Participate in audit activities and meetings.
• Audited charts and reviewed clinical documents to verify accuracy.
• Collaborated with an interdisciplinary team to determine timely delivery of services.
• Referred clients to appropriate team members, community agencies and organizations to meet treatment needs.

Bachelor of Science - Nursing - Long Island University CW Post Brookville, NY

Associates - Nursing - State University of New York Farmingdale, NY