Kimberly Mercuri

I am a dedicated Clinical RN with extensive experience in utilization review, provider collaboration, and medical record data analysis. My focus is on supporting accurate documentation and appropriate care determinations while ensuring compliance with CMS standards and best practices. I have served as a subject matter expert for training, medical policy evaluation, and clinical support during the implementation of an AI-based clinical review tool.

In my current role as a Clinical Review Nurse at TurningPoint Healthcare Solution, I evaluate medical records to validate levels of care, procedures, and diagnoses in accordance with internal policies and CMS guidelines. My in-depth clinical knowledge and critical thinking skills allow me to interpret documentation against compliance protocols and national criteria for appropriate treatment planning. I effectively communicate with providers and care teams to obtain necessary documentation for complete and accurate case assessments, while also educating peers and new hires on documentation standards and case types.

Previously, as a Registered Nurse at AdventHealth Orlando/Orthopedic Institute, I delivered direct patient care across diverse surgical and medical populations. I collaborated with case managers and physicians to ensure cohesive communication and documentation around patient progress and discharge planning. My commitment to mentoring new Nurse Residents and students has been a rewarding aspect of my career, as I strive to uphold best clinical practices and support the next generation of nursing professionals.