Jean Wiatrak
Powhatan
Summary
Dynamic Utilization Review Nurse with extensive experience at WellSense, adept at optimizing treatment plans and resource utilization. Proven track record in compliance procedures and documentation, enhancing patient care quality. Skilled in InterQual criteria and telephonic nursing, with a strong ability to collaborate effectively with healthcare teams to achieve organizational goals.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse
WellSense
05.2025 - Current
- Conducted thorough reviews of patient cases to ensure compliance with clinical guidelines.
- Collaborated with healthcare teams to optimize treatment plans and resource utilization.
- Analyzed medical records and documentation for accuracy and completeness in care assessments.
- Served as a liaison between providers and insurance companies to facilitate approval processes.
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
Utilization Review Nurse
Humana
06.2019 - 04.2025
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Improved patient care quality by conducting thorough utilization reviews and making recommendations for optimal treatment plans.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Contributed to organizational success by providing expert advice on medical necessity criteria and evidence-based practices in utilization review nursing.
Utilization Review Nurse
Sentara Healthcare
01.2014 - 06.2019
- Conducted thorough evaluations of medical necessity for procedures, leading to optimal resource utilization.
- Conducted thorough reviews of patient cases to ensure compliance with clinical guidelines.
- Collaborated with healthcare teams to optimize treatment plans and resource utilization.
Registered Nurse, Emergency Department
Sentara Princess Anne Hospital
09.2011 - 2014
- Administered critical care to patients in high-stress emergency situations.
- Collaborated with multidisciplinary teams to ensure optimal patient outcomes.
- Developed and implemented patient care plans tailored to individual needs.
- Mentored junior nursing staff, enhancing team performance and knowledge sharing.
- Streamlined triage processes, improving patient flow and response times.
- Educated patients and families on treatment options and post-discharge care.
Registered Nurse, Medical-Surgical Unit
Sentara Leigh Hospital
06.2010 - 2011
- Administered medications and treatments per established protocols, ensuring compliance with safety standards.
- Monitored and assessed patient conditions, adjusting care plans based on evolving needs.
- Developed training materials for new hires, streamlining onboarding process and improving team efficiency.
- Collaborated with unit leadership to identify workflow improvements that increased operational effectiveness in patient management.
Education
Bachelor of Science - Nursing
Old Dominion University
Norfolk, Virginia, VASkills
- Documentation and reporting
- InterQual criteria
- Utilization review
- Records analysis
- Managed care
- Discharge planning
- Medicaid
- Utilization management
- Telephonic nursing
- Compliance procedures
- Milliman guidelines
- Medicare
- Case management
Certification
Certified case manager since 2017
MCG certified care guidelines specialist since 2022
Timeline
Utilization Review Nurse
WellSense
05.2025 - Current
Utilization Review Nurse
Humana
06.2019 - 04.2025
Utilization Review Nurse
Sentara Healthcare
01.2014 - 06.2019
Registered Nurse, Emergency Department
Sentara Princess Anne Hospital
09.2011 - 2014
Registered Nurse, Medical-Surgical Unit
Sentara Leigh Hospital
06.2010 - 2011
Bachelor of Science - Nursing
Old Dominion University