Danelle Wilson

Executes complex outpatient prior authorization and utilization reviews for acute, post-acute, behavioral health, and specialty care across commercial and federal lines of business. Serves as a subject matter expert on Federal Employee Health Benefit (FEP/FEHB) plan regulations and commercial payer policies.

Established and operates an independent integrative wellness and clinical skin clinic delivering specialized light therapies, cosmetic laser rejuvenation, and holistic health consulting. Directs all corporate operations, compliance standards, HIPAA-secure scheduling workflows, and fiscal frameworks.

Conducted rigorous level-of-care and continued-stay medical necessity evaluations utilizing InterQual criteria across inpatient acute, rehabilitation, and long-term care facilities. Partnered with hospital case managers and multi-disciplinary teams to eliminate discharge barriers and ensure safe, compliant transitions of care.

Contracted across premier Atlanta healthcare systems to manage inpatient resource utilization, review admissions within 24 hours, and run multi-disciplinary daily huddles to drive clinical throughput.

Audited Medical/Telemetry clinical documentation to verify alignment with federal, state, and third-party commercial payer utilization metrics.

Led QA/PI auditing workflows for Medicare and episodic payers, verifying charting integrity, compliance with federal reimbursement guidelines, and OASIS assessment accuracy. Supervised and directed clinical delivery teams of 20+ staff members.

Provided high-acuity critical care nursing across Neurological ICU, Step-down, and Pulmonary Thoracic units. Managed acute CVAs, TBIs, and post-surgical interventions while routinely serving as Charge Nurse.

Earned an Associate Degree in Nursing from the University of Toledo in 2003.

Certified as a Laser Operator and Aesthetics specialist.

Completed Microsoft Azure AI Fundamentals and Healthcare Cloud Fundamentals certification.