Open to opportunities

Renee User

@reneeuser3

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Registered Nurse and Utilization Review expert delivering patient-centered care and cost-conscious case management.

United States

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What I'm looking for

I seek a role in utilization review or case management where I can lead care coordination, improve quality and compliance, mentor staff, and optimize patient outcomes and cost-efficiency.

I am a Registered Nurse with nearly 20 years' experience in utilization review, case management, and patient care coordination, focused on creating comfortable, effective care plans and fostering strong communication among patients, families, and multidisciplinary teams.

I have a track record of improving reporting, supporting out-of-network negotiations, and driving cost savings while maintaining quality; I developed training materials and standardized processes that improved performance and compliance with URAC, NCQA, and NCCN standards.

I consistently meet performance quotas with high on-time and audit success rates and low error rates, and I bring adaptable leadership, policy support experience, and a commitment to patient advocacy and continuous improvement.

Experience

Work history, roles, and key accomplishments

Current

Utilization Review Nurse

Current

Children’s Community Health Plan

Jan 2017 - Present (9 years 4 months)

Managed member case management and utilization reviews, reviewing pre-authorizations and inpatient admissions to ensure appropriate care; maintained 100% on-time/audit success and <1% error rate while developing training materials to optimize SOPs.

Utilization Management Case Management Care Coordination Training Development Telephonic Case Management Quality Assurance Milliman URAC NCQA Standards

Utilization Review Nurse

Conduent

Jan 2013 - Jan 2017 (4 years)

Performed precertification, concurrent review and discharge planning; supported policy and program development for care management and quality improvement while monitoring cases through to conclusion.

Concurrent Review Discharge Planning Policy Development Care Management Quality Improvement Utilization Review Pre Certification

Regional Nurse Case Manager

Extendicare Health Services

Jan 2012 - Jan 2013 (1 year)

Managed regional managed-care caseloads, standardized managed care training, and ensured compliance with authorization and re-authorization processes to align regional and corporate initiatives.

Case Management Managed Care Training Standardization Authorization Compliance Care Coordination

Utilization Review Nurse

UnitedHealthcare

Jan 2009 - Jan 2012 (3 years)

Managed members with complex medical and surgical needs across post-hospital and community settings, leading admission-to-discharge care management and consistently exceeding annual audit expectations.

Care Management Discharge Planning Clinical Assessment Utilization Review Audit & Compliance Care Coordination

Nurse Case Manager

Select Specialty Hospital-Milwaukee

Jan 2005 - Jan 2009 (4 years)

Led case management for long-term acute care patients from pre-admission through discharge, implemented a process improvement to enhance patient condition assessment and coordination with interdisciplinary teams.

Case Management Discharge Planning Process Improvement Care Coordination