Clinical Nurse Risk Management
Resume:
Clinical Nurse Professional
Expertise: Integrated Healthcare Utilization & Risk Management Complex Case/Care Management Medical Underwriting Infusions Acute Care
Extensive experience in managed care, clinical operations, and patient-centered nursing. Adept at interpreting policies, supervising teams, and maintaining compliance with CMS, DHS, URAC, AMS. Knowledgeable in Medicare/Medicaid, MSHO, Commercial, and Stop Loss. Skilled in HEDIS, STARS, CPT, ICD, and HCPC coding. Proficient with EMRs and healthcare software (EPIC, IPEX, Oasis, ABS, Relias, MMIS, InterQual, Milliman, etc.).
Professional Experience
BrightStar Care – Complex Care Private Duty Nurse
Mar 2025 – Present
Deliver in-home nursing care (trach, wound, tube feedings) with multidisciplinary team collaboration.
Educated patients/families on health management and regulatory compliance.
DaVita – Dialysis Nurse (Acutes III)
Feb 2022 – Oct 2024
Provided dialysis/renal therapies in ICU/med-surg; initiated/discontinued treatments and medications.
Analyzed labs/orders; reported complications; mentored junior teammates.
Matrix Clinical Trials – Infusion Nurse (Consultant)
Nov 2021 – Feb 2022
Administered monoclonal antibodies to COVID-19 patients; started IVs and managed central lines.
Educated on infection control and therapeutic protocols.
Interim Health – Immunization Clinic Nurse (Consultant)
Sep 2021 – Nov 2021
Delivered COVID-19 and flu vaccines; monitored post-vaccination response.
Ensured adherence to CDC/FDA storage, handling, and documentation guidelines.
ReLode/Drug Free Sports Int’l – Site Manager, COVID Testing & Vaccination
Apr 2021 – Sep 2021
Oversaw vaccine clinic delivering 2,900+ daily doses; led training, operations, and reporting.
Liaised with clients and optimized team efficiency.
QCI Healthcare – Flu Clinic Nurse Manager (Seasonal)
Nov 2017 – Dec 2019
Managed supply logistics, setup, and administration for on-site flu clinics.
Maintained high-quality documentation and patient confidentiality.
Anthem – Medical Manager, Utilization Mgmt.
Aug 2018 – Jul 2019
Reviewed inpatient medical necessity, benefits, and care settings for Medicaid population.
Coached teams on UM guidelines; liaised with providers and medical directors.
Mayo Clinic (GBS) – Integrated Case Manager (Consultant)
Jan 2018 – Jun 2018
Coordinated PCP/specialist referrals and services; developed policy and trained staff.
Built relationships with community health organizations.
Tokio Marine HCC – Medical Underwriting Nurse
Oct 2016 – Dec 2017
Reviewed high-risk claims, medical conditions, case mgmt. reports to inform underwriting.
Identified cost savings, educated teams on treatment projections and reserves.
UnitedHealth Group (Optum) – Clinical Stop Loss Analyst
Sep 2015 – Oct 2016
Managed complex cases (e.g., dialysis, transplant) with TPAs and auditors.
Reviewed investigational claims and trained new staff.
Assurant Health – Case/Utilization Management Nurse
Jun 2014 – Sep 2015
Conducted UM reviews for major medical cases; collaborated with physicians and vendors.
Focused on patient outcomes, cost containment, and compliance with URAC standards.
Medica – Utilization Management/Appeals Nurse (Consultant)
Jan 2014 – Jun 2014
Conducted prior authorizations and appeals; applied contract benefit and policy review.
Partnered with Medical Directors to ensure appropriate care delivery.
Humana Inc. – Onsite Clinical Advisor (Hospital)
Jan 2009 – Dec 2013
Onsite support for care coordination, readmission prevention, and case reviews.
Assisted with appeals, subrogation cases, and quality improvement efforts.
Education
Kaplan University – BSN, Registered Nurse
2016
Wisconsin Indianhead Technical College – AAS, RN
2001
Bemidji State & NW Technical College – AAS, Science & Technology
1999
Licenses & Certifications
MN Registered Nurse #155565-1
MN Public Health Nurse #29026
Legal Nurse Consultant
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