Megan Wassell
Mount Juliet
Summary
Achieved high-quality patient outcomes through 16 years of nursing expertise, with 5 years in bedside care and 11 years in remote utilization management. Working closely with management in the launch of Machinify AI training software. Enhanced clinical review and utilization review processes, positively impacting pre and prior auth policy. Improved efficiency by effectively managing multiple claims systems. Maximized productivity using AI systems for comprehensive data analysis. Motivated to tackle new challenges in the evolving analytical nursing landscape.
Overview
16
16
years of professional experience
1
1
Certification
Work History
RN CLINICAL REVIEWER
Evolent Health
11.2021 - Current
- Supported consistency in RN review process through application of medical review guidelines. Assisted in delivering thorough documentation with rationales that backed determinations. Aided in enhancing production and quality standards for medical review process. Fostered collaborative relationships with physicians and team members to improve efficiency. Simplified referral process for cases not meeting criteria to facilitate timely reviews. Conducted prospective, concurrent, and retrospective reviews for medical services.
RN HEDIS OVERREAD
Optum Health
01.2023 - 04.2026
- Achieved high data accuracy for outlined measures through diligent verification processes. Enhanced compliance with NCQA guidelines and abstraction standards. Improved data collection oversight through systematic audits. Elevated quality of HEDIS medical record reviews as an overreader/auditor, ensuring meticulous examination of records and abstraction team data. Provided actionable feedback from audits, leading to informed recommendations based on chart reviews. Optimized navigation of supplemental claims databases with dual monitors. Conducted thorough research as necessary. Effectively utilized Ciox EMR, ISET, ILead, RateMax, and Facets for data analysis.
Supplemental Data Collection RN-HEDIS
BCBST
05.2023 - 11.2025
- Achieved accurate retrieval and abstraction of medical record data for STARS and HEDIS, contributing to improved compliance. Enhanced quality through ongoing medical record reviews. Streamlined data loading into HEDIS applications. Maximized efficiency by operating multiple systems concurrently.
RN CARE COORDINATOR LTSS
BCBST
08.2015 - 10.2021
- Assisted in analyzing and comparing person-centered support plans for members. Reviewed issues and completed reports as directed by management. Aided in managing member cases within licensure scope. Supported non-RN clinicians in case management activities. Conducted telephonic or face-to-face clinical assessments to identify and evaluate member needs, including physical health, behavioral health, social services, and long-term services and supports. Reviewed alternative care services to provide cost-effective care management programs.
RN Staff Nurse
Williamson Medical Center Float Pool
08.2012 - 08.2015
RN
Summit Medical Center, Rehab Floor
09.2012 - 12.2013
Maury Regional Hospital Oncology
06.2011 - 08.2012
Crockett Hospital Med Surg
06.2010 - 11.2011
Education
Associate of Science - Nursing
Northwest Shoals Community College
Skills
- Utilization Mangement
- Research
- Clinical review
- Data analysis
- Claims processing
- Audit
- High level of Accuracy
Certification
- RN REGISTERED NURSE
- TN COMPACT
Timeline
Supplemental Data Collection RN-HEDIS
BCBST
05.2023 - 11.2025
RN HEDIS OVERREAD
Optum Health
01.2023 - 04.2026
RN CLINICAL REVIEWER
Evolent Health
11.2021 - Current
RN CARE COORDINATOR LTSS
BCBST
08.2015 - 10.2021
RN
Summit Medical Center, Rehab Floor
09.2012 - 12.2013
RN Staff Nurse
Williamson Medical Center Float Pool
08.2012 - 08.2015
Maury Regional Hospital Oncology
06.2011 - 08.2012
Crockett Hospital Med Surg
06.2010 - 11.2011
Associate of Science - Nursing
Northwest Shoals Community College