Open to opportunities

Tanita Green

@tanitagreen

Message

I prevent denials and deliver timely, compliant utilization reviews for Medicare and Medicaid.

United States

Message

What I'm looking for

I'm looking to apply my utilization review, denial prevention, Medicare, Medicaid, and clinical assessment experience in a role focused on timely, compliant medical-necessity decisions and improved patient access to care.

At CareCentrix, I perform post-acute referral evaluations, medical-necessity reviews, concurrent assessments, and service determinations for more than 70 patients each month using CMS, InterQual, and MCG resources.

Previously at Ciox Health and Aetna Specialty Pharmacy, I researched denials, prepared peer reviews, collaborated with medical directors and plan liaisons, and improved approval rates and turnaround times through detailed clinical review.

I've also provided direct patient care, clinical assessments, education, documentation, and adverse drug reaction reporting across specialty pharmacy, rehabilitation, assisted living, and nursing settings.

Experience

Work history, roles, and key accomplishments

Current

Post Acute Care Utilization Review Nurse-Licensed Practical Nurse

Current

CareCentrix

Jan 2022 - Present (4 years 7 months)

Performs initial evaluation of referral appropriateness and reviews information for medical necessity. Ensures case review and elevation completed within contractual and regulatory turnaround times, processing service determinations for 70+ patients per month.

Utilization Review InterQual Case Management Regulatory Compliance patient assessment