Tiana Whittlesey

Conducted remote medical record reviews to assess medical necessity and appropriateness of care based on InterQual/Milliman guidelines. Collaborated with providers and case management teams to support denial prevention and timely submission of clinical appeals, ensuring HIPAA-compliant documentation.

Reviewed patient medical histories, developed treatment plans, and performed patient education to ensure safety and efficacy of wellness and aesthetic procedures. Managed all business operations including compliance, documentation, billing, and client follow-up, ensuring optimal patient outcomes.

Provided acute nursing care in high-volume medical-surgical environments, assessing patient conditions, administering medications, and evaluating treatment effectiveness. Partnered with case managers, providers, and families to coordinate safe patient discharges and post-acute care transitions, applying InterQual and Milliman guidelines.

Conducted comprehensive patient assessments and pre-procedure clearances, ensuring all clinical data met regulatory and safety standards. Collaborated with interdisciplinary teams to manage patient care, triage risk factors, and accurately document patient status and treatment plans.

Currently pursuing advanced studies in nursing, specializing as a Family Nurse Practitioner, with a focus on comprehensive patient care across the lifespan.

Completed coursework focused on fundamental nursing principles, patient care, and clinical practice, earning a Bachelor of Science in Nursing.