Yamilet Maldonado

I am a bilingual Registered Nurse with over 17 years of healthcare experience across acute care, behavioral health, managed care, MLTC, and remote case management. I focus on utilization management, medical necessity determination, and concurrent review, with strong Epic EMR navigation skills.

Throughout my career I have conducted daily chart reviews, discharge and progress note evaluations, and documentation for level-of-care decisions including IP vs Observation status. I am familiar with InterQual® and MCG® criteria, Medicare guidelines, and escalation to physician advisors for complex cases.

In recent roles I have performed comprehensive clinical assessments, validated eligibility for services, coordinated with interdisciplinary teams, and maintained accuracy and productivity in fast-paced review environments. I have supported transitions of care, identified care gaps and clinical red flags, and ensured adherence to payer and CMS standards.

I bring a patient-centered, trauma-informed approach to case management and nursing, and I am advancing my clinical expertise as an MSN-PMHNP candidate. I am recognized for thorough documentation, cross-functional collaboration, and dependable case processing.