Experienced Utilization Review Nurse with a track record of delivering high-quality care and ensuring cost-effectiveness for patients and healthcare facilities. Skilled in assessing medical necessity and collaborating with physicians to determine appropriate classifications for optimal patient outcomes. Proficient in submitting clinical information to payers and specializing in denial review. Expertise in setting up Peer-to-Peer (P2P) discussions for physician advisors with payors. Holds a Bachelor of Science in Nursing, providing a solid foundation for a career in the healthcare industry.
References: Deanna Dekoninck RN., House Supervisor PDH. (260) 920-8728; Nora Hively UR RN: 260-248-9760; Inesa Makevit NP., (260) 431-4945; Jennifer Gillingham RPH, Kroger Pharmacy (260) 492-2054.