RN – Case Mgmt.

Experienced Registered Nurse Case Manager with 12 years of diverse clinical expertise spanning acute care, case management, and utilization review in hospital, home health, and telehealth settings. • Skilled in InterQual-based medical necessity review, concurrent review, and discharge planning to ensure compliance with regulatory and payer requirements. • Proven ability to collaborate across interdisciplinary teams to optimize care efficiency, resource allocation, and patient outcomes. • Proficient in Epic EMR, Cerner documentation, and care coordination for high-volume caseloads (1:40 ratio). • Adept at CMS, DRG, and Medicare regulation compliance, with strong knowledge of CC44s, ABNs, HINNs, and MCSNs. • Exceptional communicator with strong critical-thinking, multitasking, and leadership skills; thrives in both remote and on-site hospital utilization review units. • Committed to evidence-based nursing, patient advocacy, and adherence to CA labor, HIPAA, and Joint Commission standards.