Results-driven Registered Nurse with extensive experience in utilization review, care management, patient access, reimbursement, and quality improvement initiatives. Proven ability to evaluate medical necessity, coordinate interdisciplinary care, and optimize patient outcomes while ensuring regulatory compliance. Skilled in Epic systems, revenue cycle processes, prior authorization, and clinical documentation review aligned with CMS and payer guidelines. Adept at improving care transitions, reducing denials, and enhancing healthcare quality through data-driven decision-making and collaborative practice.