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UM Clinical Reviewer Analyst

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Dynamic UM Clinical Reviewer Senior Analyst at EviCore by Evernorth, skilled in clinical review and regulatory compliance. Proven ability to enhance communication between providers and payers, while developing educational materials. Recognized for meticulous documentation accuracy and strong problem-solving skills, fostering collaboration among healthcare professionals to drive effective outcomes.

Focused RN with 20+ total years in medical care delivers consistent and professional work for every assignment. Offers 10 years in Utilization Management industry and top-notch abilities in being a detail-oriented team player with strong organizational skills, deliver 95% and above accuracy on audit scoring. Ability to handle multiple projects simultaneously with a high degree accuracy. Trained in Prior Auth & CCR review/Managed Care: Medicare, Medicaid, and Commercial coverage. Experienced in EMR, InterQual & MCG. Unrestricted Compact State Iowa Registered Nursing License with ability to transfer RN license to different state if required. Working knowledge of Word, Excel, PowerPoint and strong typing skills.
Registered Nurse with extensive experience in utilization management, skilled in evaluating medical records and clinical documentation against established criteria such as InterQual and MCG. Demonstrated ability to assess the appropriateness of proposed treatments and coordinate care by collaborating with healthcare providers to ensure compliance with regulatory standards. Proven track record of identifying care gaps and implementing policies that enhance patient outcomes while adhering to strict timelines for review processes. Committed to maintaining accurate documentation and facilitating effective communication among interdisciplinary teams to optimize patient care delivery.

Healthcare professional with comprehensive background in obstetrical nursing with proven record at Alere/Optum, enhancing patient outcomes through meticulous clinical skills, documentation and advocacy. Recognized for strong leadership. I empower patients with self-management techniques while fostering a culture of continuous improvement. Committed to excellence in healthcare delivery and patient education. Diligent remote nurse with solid background in clinical nursing review. Skilled in assessing patient care plans and ensuring compliance with healthcare standards. Demonstrated ability to effectively analyze medical records and collaborate with healthcare teams.

Self -motivated, efficient, resourceful and reliable. Excellent communication and interpersonal skills. Confident in interactions with individuals at all levels. Resourceful in the completion of tasks with ability to multi-task efficiently. Function effectively as a team player as well as working independently. Possess strong problem solving skills. Excel in fast paced environments.

Tiffany Pritchard

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UM Clinical Reviewer Analyst

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Med-Surg LPN

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Licensed Practical Nurse - Nursing

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UM Clinical Reviewer Analyst

LPN

Med-Surg LPN

Licensed Practical Nurse - Nursing

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