Minela Malic

Provide pre-service utilization management for Medicare Advantage members by conducting clinical reviews of prior authorization requests. Apply evidenced-based criteria (MCG, InterQual) to evaluate medical necessity, level of care, and benefit coverage. Collaborate with providers and interdisciplinary teams to ensure regulatory compliance, optimize resource utilization, and support member-centered, cost-effective care.

Telehealth triage services for pediatric and adult patients across diverse medical conditions. Leverage ER expertise and multi-state licensure (Compact & non-compact) to assess patient needs, apply evidence-based protocols, and coordinate timely, effective interventions.

Provide nationwide telehealth support for patients enrolled in GLP-1 therapy programs, assisting with medication access, education, and ongoing care. Conduct comprehensive assessments, triage side effects, and collaborate with providers to ensure safe, effective treatment plans. Leverage multi-state licensure to advocate for patient needs, mentor new hires, and deliver high-quality, compassionate care in a fast-paced virtual environment.

Promoted to lead quality assessments of patient care documentation and processes, ensuring compliance with regulatory standards and driving continuous improvement initiatives. Review clinical data and patient records to identify trends, enhance care delivery, and support positive outcomes across interdisciplinary teams. Provide education and mentorship on evidenced based practices, quality metrics, and compliance requirements, while collaborating with leadership to implement effective policies and foster a culture of excellence and patient safety.

Provide telehealth-based clinical support and advocacy to patients navigating complex insurance processes and healthcare decisions. Deliver treatment decision support, triage, health education, and referrals for case and disease management, wellness, and complex medical needs. Collaborate with providers and insurance teams to resolve prior authorization requests, appeals, and coverage issues, ensuring patients have access to necessary care. Educate patients and healthcare teams on insurance policies and empower them to make informed decisions, while documenting interactions and advocating for improved processes and patient outcomes.

Provide high-quality, patient-focused care in a fast paced emergency department, serving diverse populations from pediatrics to geriatrics. Utilize advanced triage skills and critical thinking to assess, stabilize, and manage acute illnesses, trauma, and complex medical conditions. Collaborate with multidisciplinary teams to deliver efficient, compassionate care while prioritizing patient safety and positive outcome sin high-pressure environments.

Delivered holistic nursing care to patients with eating disorders, addressing physical, emotional, and psychological needs in a specialized inpatient setting. Conducted comprehensive assessments, monitored nutritional status, and collaborated with multidisciplinary teams to develop individualized treatment plans. Provided medication management, therapeutic support, and patient education to promote recovery and empower patients and families. Applied expertise in psychiatric nursing to ensure safe, compassionate, and evidence-based care.