Vanessa *
@vanessa1
I review medical necessity and improve care coordination across Medicare, hospital, and managed-care settings.
United StatesWhat I'm looking for
I've supported Medicare utilization management at Molina Healthcare and hospital care coordination at CommonSpirit, completing medical-necessity and concurrent-stay reviews, coordinating with case management and medical directors, and communicating determinations to providers.
Across more than 10 years of nursing practice, I've delivered med/surg, hospice, psychiatric, corrections, and home-health care while building strengths in clinical documentation, payer portals, EMR/EHR systems, care planning, compliance, and interdisciplinary collaboration. I'm seeking remote work where I can apply my clinical background to utilization review, nursing informatics, quality, auditing, or documentation review.
Experience
Work history, roles, and key accomplishments
Performed medical necessity reviews for inpatient hospitalizations and concurrent stay reviews for Medicare members, collaborating with interdisciplinary teams and communicating with hospital providers.
Education
Degrees, certifications, and relevant coursework
Western Governors University
Master of Nursing Informatics, Nursing Informatics
Incomplete Master of Nursing Informatics with relevant coursework in core masters nursing curriculum, data science and analytics, information management, and introductory nursing informatics.
Florida Gulf Coast University
Bachelor of Science in Nursing, Nursing
Bachelor of Science in Nursing with relevant coursework in anatomy and physiology, pharmacology, nursing ethics, and patient care management.
Availability
Location
United StatesAuthorized to work in
Job categories
Skills
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