mary nelson

With over 21 years of experience as a Lead Nurse at Elevance/Anthem Utilization, I have honed my skills in preservice concurrent home health and discharge planning. My role has allowed me to lead teams of registered nurses, ensuring that we optimize patient care and resources while maintaining high compliance rates. I take pride in training new employees on computer systems and guidelines for utilization review, fostering a culture of excellence and continuous improvement.

My responsibilities extend to auditing and training nurses who do not meet benchmarks, which has significantly enhanced our team's performance. I work collaboratively with healthcare providers and members to promote quality outcomes, ensuring that we deliver medically appropriate, high-quality, and cost-effective care. My expertise in interpreting benefits and managing care has been pivotal in navigating complex medical issues and optimizing member benefits.