Lisa Mousty

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Clinical Implementation Consultant

Xsolis (Remote)

Sep 2024 - Feb 2026 (1 year 6 months)

Implemented and supported AI-driven software in 11 health systems (spanning over 100 individual hospitals) and 15 Payer Connections. Led enterprise and facility-level deployments, supporting integration of technology into existing hospital workflows and care delivery processes. Analyzed documentation and utilization trends to identify workflow gaps impacting patient status, length of stay, and regulatory alignment. Delivered customized provider education, workflow redesign strategies, and live training sessions to drive adoption and operation efficiency. Collaborated with product and analytics teams to provide clinical feedback and improve how the platform functioned within hospital workflows.

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Prior Authorization Nurse 2 / Case Manager

Humana - iCare

Aug 2020 - Current (6 years 2 months)

Reviewed inpatient clinical documentation to assess medical necessity, patient status, and length of stay across Medicare, Medicaid, and commercial populations. Performed high-volume inpatient medical necessity reviews using InterQual and MCG criteria, ensuring alignment with payer requirements and quality standards. Facilitated concurrent, retrospective, and prospective authorization determinations, including approvals and denials, while identifying trends impacting utilization and cost. Collaborated closely with Medical Directors on escalated cases involving denials, appeals, prolonged length of stay, and complex clinical or social barriers. Analyzed utilization patterns, documentation gaps, and discharge planning factors impacting payer

Registered Nurse - Corporate Utilization Management

Lee Health

Jun 2017 - Jun 2020 (3 years 1 month)

Served as embedded Clinical Rounder during interdisciplinary rounds, providing real-time recommendations to hospitalists and care teams to ensure accurate patient status, documentation integrity, and regulatory compliance. Functioned as subject matter expert for UM staff and providers across Epic, MCG, InterQual, EQ Health, CPT/ICD coding, and Xsolis/Cortex platforms. Led discharge coordination initiatives that expedited patient flow and reduced avoidable delays.

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Registered Nurse - Acute & Specialty Care

Jan 2013 - Jan 2017 (4 years 1 month)

Provided direct patient care and charge nurse oversight in high-acuity medical-surgical and hematology/oncology settings. Coordinated staffing, admissions, and unit workflow while ensuring documentation accuracy and patient safety. Trained and mentored newly hired nurses and supported adherence to specialized clinical protocols.

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Lisa Mousty

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