utilization reviewer, clinical auditor

Experienced Utilization Management Nurse Reviewer with over five years of expertise in evaluating medical necessity using MCG and InterQual criteria. MCG and InterQual certified, with a strong background in determining appropriate patient status, including inpatient and observation level of care, through thorough clinical review and evidence-based decision-making.

Highly detail-oriented and committed to producing accurate, high-quality reviews while consistently meeting productivity goals. Proficient in electronic health record systems, including Cerner, Epic, and WebHis. I am resilient with strong critical thinking, and the ability to work efficiently under pressure and extended hours while maintaining accuracy and compliance with utilization management standards.