Open to opportunities

Dawn Bellan

@dawnbellan

Clinical Analyst and LPN with 25+ years helping resolve utilization management appeals through CMS-compliant, evidence-based reviews.

United States

Message

What I'm looking for

I’m looking to advance in utilization management and clinical appeals, using InterQual and CMS guidance to deliver accurate coverage decisions, strengthen compliance, and improve audit outcomes within a collaborative healthcare team.

I bring 25+ years of healthcare experience, with 15+ years specializing in utilization management, clinical appeals, Medicare review, and medical necessity determinations. I focus on accurate coverage outcomes by applying CMS regulations, InterQual criteria, LCD/NCD policies, and evidence-based guidelines.

In my roles, I perform medical necessity reviews, appeals analysis, documentation review, and compliance evaluations. I also strengthen denial management through structured provider communication, trend analysis, and audit-ready clinical documentation.

As a Clinical Review Supervisor, I led quality audits, training, and workflow improvement initiatives, including Inter-Rater Reliability reviews. I consistently prioritize HIPAA compliance, quality assurance, and regulatory oversight to support defensible decisions and continuous process improvement.

Experience

Work history, roles, and key accomplishments

Current

Clinical Reviewer

Current

Acentra Health

Jan 2021 - Present (5 years 5 months)

Performed medical necessity reviews, documentation review, and appeals analysis using InterQual criteria and CMS guidelines to support accurate coverage determinations. Conducted compliance evaluations to ensure adherence to regulatory and policy requirements.

Medical Necessity Criteria InterQual Guidelines Clinical Documentation Review Compliance Evaluation Utilization Management Denial Management Quality Assurance Medicare Reviews

Clinical Review Supervisor

Acentra Health

Jan 2020 - Jan 2021 (1 year)

Supervised clinical review staff and supported quality audits and Inter-Rater Reliability reviews. Drove training and workflow improvement initiatives to strengthen review consistency and outcomes.

Quality Audits Clinical Appeals Workflows Training Compliance Monitoring Clinical Documentation Review Process Improvement

Preauthorization Nurse

Capital Blue Cross

Jan 2017 - Jan 2020 (3 years)

Conducted utilization management reviews and supported provider outreach regarding authorization requirements and clinical documentation standards. Ensured reviews aligned with coverage and compliance expectations.

Utilization Management Authorization Clinical Documentation Medical Necessity Review Compliance Support Denial Management Quality Assurance HIPAA compliance

Nurse Reviewer

Kepro

Jan 2016 - Jan 2017 (1 year)

Reviewed medical records to support quality determinations, appeals, and medical necessity decisions. Analyzed documentation to ensure decisions were consistent with applicable review criteria and policies.

Medical Record Review Clinical Appeals Medical Necessity Criteria Utilization Review Documentation Analysis Compliance Evaluation Denial Management

Nurse Analyst

Novitas Solutions

Jan 2012 - Jan 2016 (4 years)

Performed Medicare medical record audits and applied LCD/NCD policies to support coverage and reimbursement determinations. Conducted detailed documentation review to ensure alignment with Medicare requirements.

Medical Necessity Review Coverage Determination Reimbursement Analysis Clinical Documentation Review Quality Assurance Compliance Review

Appeals Coordinator

WVMI / Quality Insights

Jan 2010 - Jan 2011 (1 year)

Coordinated Medicare appeals by researching regulations and analyzing medical records to support physician review processes. Helped ensure appeals documentation was organized and compliant with applicable requirements.

Medicare Appeals Process Medical Record Review Documentation Review Quality Assurance Case Management