Natalyn McPhie Receptionist at University of South Alabama

Nurse consultant

Maximus, Inc.

May 2026 - Current (3 months)

Served as an independent, neutral clinical reviewer on behalf of the Qualified Independent Contractor (QIC) portal, adjudicating complex Medicare Part A appeals. Upheld strict federal quality standards by validating or overturning prior Medicare Administrative Contractor (MAC) decisions based purely on clinical evidence. Managed a high-volume independent caseload, maintaining an average productivity rate of 90 cases per week while meeting 95% of stringent contractual deadlines. Cross-referenced medical chart data against InterQual/MCG criteria and the CMS Medicare Benefit Policy Manual to ensure bulletproof compliance on every determination. Identified technical documentation errors and billing discrepancies, providing clear, legally and cl

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Field Case Manager/RN

Genex Services

Jun 2025 - Current (1 year 2 months)

Perform medical necessity reviews for complex, high-cost inpatient cases using ODG and evidence-based guidelines, ensuring appropriate level of care and alignment with Medicare/Medicaid requirements. Conduct concurrent review and coordinate care across providers, employers, and carriers to support safe, cost-effective treatment and timely return-to-work outcomes. Prepare clinical summaries and escalate cases to physician leadership when criteria are not met, supporting medical director review and decision-making. Analyze utilization patterns, identify variances, and document all determinations in care management systems with accuracy and timeliness. Assess psychosocial and medical barriers, coordinating interventions across the continuum of

Telephonic Case Manager/ RN - Contract

Monogram Health

Mar 2025 - Jul 2025 (5 months)

Performed telephonic and in-home assessments, applying clinical guidelines to evaluate medical necessity, care gaps, and appropriateness of ongoing treatment. Collaborated with physicians and interdisciplinary teams to review and modify care plans based on clinical progress and evidence-based criteria. Monitored biometric data and initiated timely interventions aligned with approved care management protocols. Documented all clinical reviews, interventions, and determinations in electronic systems to support continuity of care and reporting accuracy. Identified members appropriate for care coordination programs and facilitated transitions across the continuum of care.

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Nursing Informaticist Internship

Piedmont Hospital

Sep 2024 - Nov 2024 (3 months)

Analyzed clinical workflows and documentation processes to identify opportunities for improved accuracy, efficiency, and standardization. Supported technology-driven quality and safety initiatives, enhancing usability and reducing documentation variance. Collaborated with clinical leadership to align informatics improvements with organizational goals and regulatory requirements. Provided on-site support to clinicians to improve adoption of optimized workflows and documentation practices.

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Telehealth Triage Registered Nurse

VHA Clinical Contact Center VA Health Connect

Mar 2024 - Oct 2025 (1 year 8 months)

Conducted virtual triage and clinical assessments, applying evidence-based criteria to determine appropriate care level, escalation needs, and resource utilization. Documented clinical encounters in EHR systems with precision, ensuring timely and accurate communication across interdisciplinary teams. Supported workflow optimization and quality assurance processes, improving documentation reliability and care coordination efficiency. Educated staff on clinical applications and documentation standards, strengthening consistency in review and decision-making. Contributed to quality improvement initiatives by analyzing trends, identifying care gaps, and supporting system-level enhancements.

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Registered Nurse, PRN

Anesthesia Service

May 2023 - Feb 2025 (1 year 10 months)

Assessed patient readiness and postoperative recovery, escalating concerns based on clinical judgment and established safety guidelines. Maintained accurate perioperative documentation to support regulatory compliance and quality review processes. Collaborated with anesthesiologists and multidisciplinary teams to ensure safe, efficient procedural care. Educated patients and families on postoperative expectations, discharge instructions, and follow-up care.

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Travel Registered Nurse

Ochsner Medical Center - Snap Nurse

Sep 2021 - May 2022 (9 months)

Delivered acute care nursing services, applying clinical judgment to support safe, appropriate treatment and escalation decisions. Documented patient care accurately in EHR systems, supporting quality review and regulatory compliance. Collaborated with interdisciplinary teams to coordinate care and ensure adherence to evidence-based standards. Participated in quality initiatives by analyzing data trends and identifying opportunities for improved outcomes.

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Travel Registered Nurse

Okaloosa County Health Department - Maxim Healthcare

Feb 2021 - Jun 2021 (5 months)

Conducted clinical assessments and screenings, applying public health guidelines to determine appropriate care and follow-up. Documented vaccination and assessment data accurately to support state and federal reporting requirements. Educated patients on preventive care and post-vaccination expectations, ensuring clarity and safety.

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Registered Nurse/Nurse Leader and Case Manager

Mobile County Public School System

Jul 2018 - May 2021 (2 years 11 months)

Performed clinical assessments and developed individualized care plans for students with chronic and complex conditions. Coordinated care across families, providers, and school staff to ensure continuity and adherence to regulatory standards. Maintained accurate health documentation and supported compliance with privacy laws and healthcare regulations. Led school-wide health initiatives and provided education to improve safety, wellness, and care coordination.

Natalyn McPhie

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