When attorneys hire a nurse consultant, they are often dealing with a patient who became acutely ill, was hospitalized, experienced a complication, and then suffered a bad outcome.

That’s exactly the environment I’ve spent 20 years navigating.

Attorneys need help navigating:

• Medical events that lead to delay in diagnosis and treatments with a failure to recognize deterioration

• Escalation of care

• Documentation of patient care

• Communication breakdowns

• Medication errors

• Discharge decisions

What Sets Me Apart?

I already speak that language. I have been navigating the areas of utilization review and case management for over a decade.

I have reviewed and evaluated hundreds of complex inpatient cases involving medical necessity, level-of-care determinations, discharge planning, and utilization management.

I have authored successful clinical appeals resulting in the recovery of hundreds of thousands of dollars in denied reimbursement through medical necessity analysis and documentation review.

Many legal nurse consultants can explain what happened clinically. Far fewer can explain:

1. What happened clinically,

2. Why decisions were made from a utilization management perspective, and

3. Whether the documentation supports those decisions.

This niche is uniquely mine. For over a decade, I have served as a clinical resource for physicians, case managers, payors, and interdisciplinary teams regarding documentation and medical necessity issues.

I demonstrate expertise in synthesizing large volumes of medical information into concise and actionable clinical assessments, which gives me unique experience that is highly relevant to:

• Medical necessity disputes

• Insurance denials

• Managed care litigation

• Discharge planning failures

• Readmissions

• Care coordination failures

• CMS and quality issues

I already know how to understand these complex records. I can find important facts quickly, create clear and concise medical timelines, and easily identify potential strengths and weaknesses in a case.

I can evaluate:

• Was the discharge appropriate? Was there documentation supporting discharge?

• Were utilization criteria met?

• Were case management interventions adequate?

• Were follow-up plans reasonable?

• Were warning signs documented?