Open to opportunities

Teena Teran

@teenateran

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Senior Registered Nurse specializing in inpatient case management and utilization review.

United States

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What I'm looking for

I’m looking for a role where I can lead inpatient case management and utilization review, using InterQual/MCG to ensure compliant medical necessity decisions. I want strong payer/interdisciplinary collaboration, room for process improvement, and the flexibility of independent workflows.

I’m a Registered Nurse with 10+ years of experience driving inpatient case management, utilization review, care coordination, and behavioral health support. I’m results-driven and focused on safe discharge planning, appropriate patient progression, and compliant clinical documentation.

In my current role as an Inpatient Case Manager / Utilization Review Nurse, I perform medical necessity reviews using MCG and InterQual criteria to determine inpatient versus observation status. I collaborate with providers, payers, and interdisciplinary teams to support safe discharge planning and regulatory/insurance compliance.

I thrive in independent, remote, and telephonic workflows—conducting assessments, managing concurrent review processes, and maintaining productivity, accuracy, and workflow efficiency. I’ve worked across multiple care settings and EMR systems including Epic, Cerner, and Allscripts, and I document reviews in tools such as Qualitrac and proprietary payer systems.

I’m also a process-improvement minded teammate: I’ve developed a Standard Operating Procedure (SOP) for transportation selection to improve medical necessity compliance and reduce inappropriate resource utilization. Recognized through awards and nominations for patient care excellence and collaboration, I bring strong leadership and charge nurse support when needed.

Experience

Work history, roles, and key accomplishments

Current

Inpatient Case Manager (UR)

Current

Anne Arundel Medical Center

May 2024 - Present (2 years 2 months)

Performed medical necessity reviews using MCG and InterQual to determine appropriate inpatient versus observation status. Collaborated with providers, payers, and interdisciplinary teams to support safe discharge planning and compliant documentation, and developed an SOP to improve transportation selection compliance.

Utilization Review InterQual Discharge Planning Clinical Documentation Review Epic SOP Development

Inpatient Care Coordinator

Aya Healthcare

Jan 2023 - May 2024 (1 year 4 months)

Supported inpatient case management with concurrent review assistance and discharge coordination at Anne Arundel Medical Center. Reviewed patient records with third-party payers to support appropriate length of stay and applied utilization review standards within hospital workflows.

Case Management Concurrent Review InterQual Clinical Documentation Epic Care Transitions

Inpatient Care Coordinator

HSHS St. Vincent Hospital

Jan 2022 - Jan 2023 (1 year)

Coordinated post-acute transitions and assessed high-risk patients requiring additional support. Partnered with physicians, nursing teams, and social work to improve care continuity and reduce readmission risk.

High Risk Patient Care Care Coordination Interdisciplinary Collaboration Clinical Documentation Discharge Planning EMR Support Patient Continuity

Medical Surgical Nurse

Aurora Medical Center

Jan 2021 - Jan 2022 (1 year)

Provided bedside medical-surgical nursing care for post-operative and chronic care populations. Administered medications, monitored patient conditions, and maintained accurate documentation in Cerner EMR.

Medical Surgical Nursing Patient Monitoring Clinical Documentation Cerner Vitals Monitoring

Utilization Review Nurse

Centene Corporation

Jan 2020 - Jan 2021 (1 year)

Conducted telephonic utilization reviews for urgent/emergent cases and continued stay requests. Applied InterQual criteria and documented reviews in Qualitrac and proprietary systems to maintain payer compliance standards.

Telephonic Utilization Review Utilization Review Medical Necessity Review InterQual Continued Stay Reviews Qualitrac Case Documentation

MCO Care Coordinator

ACO Partner

Jan 2018 - Jan 2019 (1 year)

Completed telephonic assessments to identify healthcare needs, barriers, and care gaps. Coordinated referrals and worked with interdisciplinary teams while managing independent caseloads to improve member outcomes.

Telephonic Care Coordination Care Gap Identification Referral Coordination And Interdisciplinary Teams Member Education Remote Case Management Clinical Support

Community Care Coordinator

Presbyterian Healthcare Services

Jan 2017 - Jan 2018 (1 year)

Performed in-home assessments addressing medical, functional, and psychosocial needs. Coordinated community resources and follow-up using electronic care management systems to improve health outcomes.

In Home Assessment Follow Up Systems Case Documentation Care Transitions

Emergency Room Nurse

Randstad USA

Jan 2016 - Jan 2017 (1 year)

Provided emergency nursing care in high-volume ER settings across Rhode Island and Maryland. Managed triage, medication administration, patient monitoring, and clinical documentation with efficient workflow in fast-paced environments.

Emergency Nursing Triage Patient Monitoring Clinical Documentation High Volume ER Workflow

Inpatient Care Coordinator

Stability Healthcare

Jan 2023 - Present (3 years 6 months)

Assessed patient needs and coordinated safe discharge planning using InterQual and hospital clinical tools. Rapidly adapted across healthcare environments and EMR systems including Epic and Cerner to support care continuity.