Technologically savvy and experienced DME Utilization Management and 7th season HEDIS Nurse with progressive experience abstracting data, overreading, QSHR, ratemax, and prior authorizations. Dependable and organized collaborator with the ability to communicate effectively and efficiently. Skilled at abstracting all 13 Hybrid measures with a 98% + accuracy rate. Experienced with using nationally accepted criteria (Interqual, Milliman.) Conducts remote and telephonic prospective, concurrent, and retrospective reviews. 15 years total Nursing experience. Areas of expertise: Remote HEDIS Nurse Data Abstraction 5

• 7 Abstractions/Overreads per hour 98%+ accuracy rate 20+ Prior Authorizations per day Utilization Review Citrix 3-5 Ratemax per hour Trained in all 13 Hybrid HEDIS measures Quality Clinical Review Medical coding QSHR InterQual VPN NCQA adherent MS office DME Case Management MCG Chronic Care Manager Claims Research Remote HEDIS Nurse Data Abstraction 5
• 7 Abstractions/Overreads per hour 98%+ accuracy rate 20+ Prior Authorizations per day Utilization Review Citrix 3-5 Ratemax per hour Trained in all 13 Hybrid HEDIS measures Quality Clinical Review Medical coding QSHR InterQual VPN NCQA adherent MS office DME Case Management MCG Chronic Care Manager Claims Research