Wendy Robson
Orland Park
Summary
Highly Experienced RN with over 11 years of experience in Utilization Review/Case Management in a variety of settings all across the revenue cycle from Acute Inpatient to the Payer side of UR. Additionally, extensive experience in Care Coordination, Managing Pre-Bill Status and Management of Denials.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse Consultant
Netsmart
12.2024 - Current
- Review patient records using electronic health record systems to assess the appropriateness of services provided and ensure compliance with clinical guidelines for Inpatient, OBS, Bedded outpatient stays for all age range ( infants through adults).
Utilization Review Nurse
Ascension
12.2018 - 11.2024
- Hospital Stay Status Review (Initial/Concurrent/Retro); IP, OBS, OP
- Collaborate/Communicate with interdisciplinary team
- Collaboration with Insurance Verification Team
- Managed case load that spanned Infants, Pediatricsc and Adutls across 2 EMR’s & 6 facilities.
- Managed Pre-Bill Status
- Manage Denials
- Handle Medicare & Managed Medicare/Medicaid
Concurrent Review Nurse
Centene
12.2014 - 12.2017
- Performed Initial & Concurrent Reviews evaluating medical necessity for Acute, LTAC, Subacute & Acute Rehab
- Worked with Multidisciplinary Team to Manage Denials
Case Manager/Utilization Review
Kindred Lakeshore Hospital
06.2013 - 11.2014
- Performed Medical Necessity Reviews on medically complex patients
- Managed Discharge Planning
Staff RN, Same Day Surgery
Advocate Illinois Masonic Medical Center
11.2011 - 06.2013
- Pre-Surgical Case Review/Collaboration with Medical Team
- Pre & Post-Op Patient Care
- Patient Education/Discharge Planning & Follow Up
Staff RN (Ortho/Med Surge/Tele)
Presence Saint Joseph Hospital
07.2009 - 07.2010
Education
Associate Degree In Applied Science - Nursing
Truman College
Chicago, IL06.2009
Licensed Practical Nurse - Nursing
Wilbur Wright College
Chicago, IL06.2008
High School Diploma -
Evanston Township High School
Evanston, IL05.1991
Skills
- MCG
- Interqual
- ICD Codes
- DRG
- EQ Health
- EPIC
- MIDAS
- Meditech
- Availity
- Payer Portals
- Microsoft
- Word
- Excel
- OutLook
- Zoom
- CDS Desktop
- Right Fax
- R1
- Google Meets
Certification
- Registered Professional Nurse, 041.377449, 05/31/26
- Pharmacy Technician, Kennedy King College, Chicago, IL, 2008, 049.185684
- Licensed Practical Nurse, Wilbur Wright College, Chicago, IL, 2007, 043.104216
Timeline
Utilization Review Nurse Consultant
Netsmart
12.2024 - Current
Utilization Review Nurse
Ascension
12.2018 - 11.2024
Concurrent Review Nurse
Centene
12.2014 - 12.2017
Case Manager/Utilization Review
Kindred Lakeshore Hospital
06.2013 - 11.2014
Staff RN, Same Day Surgery
Advocate Illinois Masonic Medical Center
11.2011 - 06.2013
Staff RN (Ortho/Med Surge/Tele)
Presence Saint Joseph Hospital
07.2009 - 07.2010
Associate Degree In Applied Science - Nursing
Truman College
Licensed Practical Nurse - Nursing
Wilbur Wright College
High School Diploma -
Evanston Township High School
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