Registered Nurse with extensive experience in Utilization Review, clinical documentation review, and medical necessity determination. Skilled in evaluating inpatient and outpatient cases against established clinical criteria, coordinating with healthcare providers, and ensuring appropriate level of care and regulatory compliance. Experienced in reviewing medical records, interpreting laboratory and diagnostic findings, preparing detailed clinical summaries, and supporting authorization and appeals processes. Strong analytical, organizational, and communication skills with a commitment to quality patient care, accurate documentation, and efficient healthcare resource utilization. Proficient in multidisciplinary collaboration, case management support, and evidence-based decision-making within fast-paced healthcare environments.
