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Deirdre Hart

@deirdrehart

Message

I accelerate appropriate care approvals through evidence-based utilization review and care coordination.

United States

Message

What I'm looking for

I'm looking to apply utilization review and care-coordination experience to improve timely, appropriate care access while supporting payer compliance, quality measures, and audit readiness.

At Centene and Humana Military, I delivered concurrent and retrospective utilization reviews for Marketplace, Medicare, and Medicaid members, applying InterQual and MCG criteria to support appropriate, timely care.

I partner with providers, physicians, case managers, and payers to expedite approvals, recommend appropriate levels of care, reduce inappropriate admissions, and improve patient access. My work supports CMS, NCQA, LCD/NCD, and HEDIS quality requirements while maintaining audit readiness.

Earlier, I coordinated perioperative care at WakeMed Hospital and provided telephonic COVID-19 case management at Duke University Hospital, helping reduce avoidable ER visits by 20% and achieving a 95% satisfaction rate.

Experience

Work history, roles, and key accomplishments

Utilization Review RN

Centene Corporation

Jun 2025 - May 2026 (11 months)

Delivered concurrent and retrospective utilization review for Marketplace, Medicare, and Medicaid cases using InterQual criteria, ensuring accurate HEDIS Quality Measures. Supported audit readiness and strengthened payer compliance by applying standardized review processes aligned with CMS and NCQA.

Utilization Review InterQual HEDIS CMS NCQA Care Coordination Documentation Payer Compliance

Utilization Review RN

Humana Military

Aug 2023 - Jun 2025 (1 year 10 months)

Conducted utilization review for 38–45 daily cases using InterQual and MCG guidelines; reduced inappropriate admissions by documenting alternate care pathways and recommending level-of-care changes. Ensured compliance with LCD/NCD policies and payer regulations, improving audit readiness, and reducing denials.

Utilization Review InterQual MCG LCD NCD Compliance Care Coordination Documentation Denial Management

Clinical Nurse II

WakeMed Hospital

Feb 2021 - Jul 2023 (2 years 5 months)

Coordinated perioperative care for 15–20 weekly neurosurgical and general surgery cases, ensuring sterile technique and 100% adherence to AORN standards, reducing risk of surgical site infections. Advocated for patient safety by monitoring physiological stability intra-operatively and assisting anesthesia team, preventing adverse events and supporting smooth recoveries.

Perioperative Care AORN Standards Sterile Technique Patient Safety Teamwork OR Tools

RN Case Manager

Duke University Hospital

Oct 2020 - Feb 2022 (1 year 4 months)

Managed COVID-19 triage through telephonic case management, reducing avoidable ER visits by 20% through timely patient education and early intervention. Educated diverse populations on preventive health practices, isolation protocols, and symptom monitoring, increasing compliance and reducing community transmission.

Case Management Telephonic Triage Patient Education Covid 19 Remote Care Documentation