

Utilization Management Nurse focused on medical necessity review, post-service claims analysis, and accurate abstraction of clinical documentation, completing 61+ medical reviews per week. Uses critical thinking and effective communication to support defensible review decisions and timely case resolution. Maintains accuracy under pressure across changing review priorities.
Post-service clinical claims review
Medical abstraction
Attention to details
Clinical documentation review
HIPAA Protocol adherence
Utilization reviews - Outpatient
Utilization reviews - Ancillary services
Retrospective review
Medical necessity review
Clinical documentation
Clinical judgment
Licensed RN
Benefit determination
Electronic health records management
Compassion and empathy
Team coordination
Can work under pressure
Fast learner
Complex Problem-solving
Data collection