Looking for a job

Maile Villarreal

@mailevillarreal

Message

I evaluate care plans against medical necessity criteria to support timely, compliant patient care.

United States

Message

What I'm looking for

I'm looking to continue supporting high-quality, compliant patient care through utilization review, medical necessity assessment, care coordination, and collaboration with interdisciplinary healthcare teams.

At Curana Health, I evaluate patient care plans against CMS and MCG medical necessity criteria, partner with interdisciplinary teams on complex cases, and communicate denial rationale and appeal rights.

I've also supported post-acute and prior authorization reviews at CareCentrix and MDX Hawaii/Agilon Health, expediting clinical decisions, maintaining regulatory compliance, and helping preserve continuity of care.

Experience

Work history, roles, and key accomplishments

Current

Utilization Review Nurse

Current

Curana Health

Dec 2025 - Present (9 months)

Evaluated patient care plans for compliance with CMS and MCG medical necessity criteria. Partnered with interdisciplinary teams to resolve complex cases and communicated denial rationale to members.

Utilization Review CMS Medical Necessity Criteria Interdisciplinary Collaboration Denial Management HIPAA

Post Acute Clinical Nurse

CareCentrix

Jul 2022 - Oct 2025 (3 years 3 months)

Documented patient care and outcomes in EHR systems while maintaining healthcare regulatory compliance. Expedited clinical decisions by obtaining missing documentation from healthcare providers.

Clinical Documentation Regulatory Compliance Care Coordination Escalation Management

Prior Authorization Review Nurse

MDX Hawaii/Agilon Health

Jun 2015 - Jan 2022 (6 years 7 months)

Evaluated authorization requests against medical necessity criteria to ensure regulatory compliance. Processed DME, home health, and outpatient procedure requests within mandated timeframes.

Medical Necessity Criteria Regulatory Compliance DME Home Health Time Management