Nazarene D.

👩‍⚕️ US-NY Licensed Registered Nurse | 🏥 Clinical Quality Assurance & Home Health Operations | 🧠 Behavioral Health Utilization Management | 💻 Medical Virtual Assistant | 📋 Prior Authorization & Insurance Coordination 💼 Who Am I? I am a dedicated and results-driven Registered Nurse with a strong clinical background and extensive experience supporting U.S. healthcare operations. My expertise combines clinical knowledge, medical administration, utilization management, prior authorizations, insurance coordination, and quality assurance across home health and behavioral health settings. With experience in hospital nursing and remote healthcare operations, I have developed the ability to bridge clinical and administrative workflows, ensuring accurate documentation, efficient processes, regulatory compliance, and continuity of patient care. I have worked in various healthcare roles, including Clinical Quality Assurance Nurse, Utilization Management Nurse Reviewer, Behavioral Health Utilization Review Nurse, and Medical Virtual Assistant. These experiences have strengthened my ability to manage complex healthcare workflows, collaborate with multidisciplinary teams, and independently resolve clinical and administrative challenges. 🔥 What I Bring to the Table ✅ Clinical Review & Utilization Management: Skilled in clinical documentation review, medical necessity assessments, and behavioral health utilization reviews across multiple levels of care. ✅ Prior Authorization & Insurance Coordination: Experienced in insurance verification, authorization submissions, tracking, payer follow-ups, and navigating various insurance portals. ✅ Home Health Operations & Quality Assurance: Proficient in patient intake, referral coordination, OASIS reviews, Plans of Care, recertifications, and clinical documentation compliance. ✅ Medical Billing & Denial Management: Experienced in home health billing support, claims review, denial investigation, and coordinating corrections and resubmissions. ✅ Medical Virtual Assistance & Patient Coordination: Skilled in patient scheduling, medical records management, provider communication, and administrative healthcare support. ✅ EHR/EMR & Technology: Experienced with HCHB, Kipu, Alleva, BestNotes, Sunwave, InMyTeam, Google Workspace, and Microsoft Office. ✅ HIPAA Compliance & Confidentiality: HIPAA certified, with a strong commitment to patient privacy, secure documentation, and regulatory compliance. 💡 Why Work With Me? 🔹 Clinical Expertise Meets Administrative Efficiency: As a Registered Nurse, I bring clinical understanding to healthcare administrative tasks, allowing me to recognize documentation gaps, understand medical necessity requirements, and support informed decision-making. 🔹 Independent & Resourceful: I am comfortable managing responsibilities remotely, researching payer requirements, coordinating with stakeholders, and following through on tasks with minimal supervision. 🔹 Detail-Oriented & Organized: Whether reviewing clinical documentation, tracking authorizations, or coordinating patient services, I prioritize accuracy, completeness, and timely follow-ups. 🔹 Proactive Problem Solver: I don't simply process tasks. I identify potential issues, communicate concerns, and work toward practical solutions that improve healthcare workflows. 🔹 Adaptable & Tech-Savvy: I learn new healthcare platforms and processes quickly and can adapt to different practice needs, payer requirements, and clinical workflows. 🔹 Patient-Centered & Professional: I understand that efficient healthcare administration directly affects patient care, provider productivity, and continuity of services. 🎯 How I Can Support Your Healthcare Practice Whether you need assistance with clinical documentation review, behavioral health utilization management, prior authorizations, home health operations, insurance verification, medical billing support, or general medical virtual assistance, I can provide reliable, organized, and clinically informed support. My goal is to help healthcare providers reduce administrative burdens, improve workflow efficiency, and focus more on delivering quality patient care. 📩 Let's connect! I'd welcome the opportunity to bring my clinical knowledge, healthcare administration experience, and commitment to excellence to your team.