
Experienced and results-driven Emergency Room Registered Nurse with 5 years of acute care expertise and a strong foundation in clinical assessment, evidence-based decision-making, and patient advocacy. Proven ability to evaluate medical necessity, apply utilization review criteria (InterQual, MCG), and ensure compliance with payer guidelines while maintaining focus on quality outcomes and cost-effective care. Adept at interpreting complex clinical documentation, collaborating with interdisciplinary teams, and communicating effectively with providers and insurance representatives. Seeking a remote Utilization Review Nurse role to leverage critical thinking, chart review proficiency, and comprehensive clinical knowledge to support appropriate utilization of healthcare resources and optimize patient care delivery.