Rocky Mount, North Carolina, United States
Registered Nurse with nearly 10 years of experience across emergency nursing, home infusion therapy, and utilization management. I specialize in complex patient care coordination, clinical documentation review, and ensuring appropriate, evidence-based care for patients with chronic and high-acuity conditions. My background includes experience with prior authorization, infusion therapy, medication management, and interdisciplinary collaboration to support safe and effective patient outcomes. Previously worked in utilization management with CVS Health, reviewing clinical documentation and applying evidence-based guidelines to support coverage determinations. Current Family Nurse Practitioner student at Winston-Salem State University with a continued focus on improving access to high-quality care. Core Areas of Expertise • Utilization Review • Prior Authorization • Clinical Documentation Review • Case Management • Infusion Therapy • Evidence-Based Practice • Interdisciplinary Care Coordination Open to remote clinical review, utilization management, and case management roles.
• Administer specialty infusion therapies including IVIG, biologics, and hydration for patients with complex chronic conditions • Review physician orders and patient clinical documentation to ensure safe and appropriate therapy • Coordinate care with specialty pharmacy teams, providers, and case managers to support treatment outcomes • Monitor patient response to therapy and communicate updates to providers • Maintain accurate documentation to ensure regulatory and payer compliance
• Coordinated care for patients receiving specialty infusion therapies in home settings • Reviewed clinical documentation, physician orders, and treatment plans to ensure appropriate therapy and safety • Collaborated with pharmacists, physicians, and case managers to coordinate infusion services and ongoing patient care • Provided patient education regarding medication administration, treatment expectations, and adverse reactions • Supported continuity of care and documentation compliance within CVS specialty infusion services
• Applied standardized clinical protocols to assess symptoms and determine appropriate level of care for patients in a remote triage environment. • Provided clinical decision support and patient education while managing a high-volume call queue. • Coordinated patient care recommendations, referrals, and follow-up instructions to support safe transitions of care. • Documented assessments and care recommendations in EPIC while maintaining regulatory and documentation compliance.
• Performed rapid clinical assessments and interventions for patients presenting with acute and high-acuity conditions. • Determined escalation of care, admission needs, or safe discharge based on clinical presentation and evidence-based protocols. • Collaborated with physicians, specialists, and care teams to coordinate patient care and treatment plans. • Supported discharge planning and referrals to ensure safe care transitions and continuity of care. • Served as a clinical resource and preceptor for new nursing staff.
• Conducted utilization and medical necessity reviews using InterQual and MCG guidelines to determine appropriate level of care for inpatient and outpatient services. • Reviewed 50+ clinical cases per week, evaluating documentation, treatment plans, and admission criteria to support coverage determinations. • Collaborated with medical directors, case managers, and providers to resolve authorization requests and ensure appropriate care coordination. • Applied evidence-based clinical guidelines to support payer decisions while maintaining regulatory compliance. • Maintained high productivity benchmarks and quality metrics in a fully remote utilization management environment.