Kristyn Kuykendall

About Kristyn Kuykendall

Compassionate, tech savvy, detail-oriented, hard-working compact licensed registered…

Experience

1. Medical Management Nurse

   Elevance Health

   Jan 2025 — Present

   The Medical Management Nurse is responsible for review of the most complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment of member’s clinical presentation to determine whether to approve requested service(s) as medically necessary. Works with healthcare providers to understand and assess a member’s clinical picture. Utilizes nursing judgment to determine whether treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not satisfy relevant clinical criteria. Acts as a resource for Clinicians.* Utilizes nursing judgment and reasoning to analyze members’ clinical information, interface with healthcare providers, make assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity.* Works with healthcare providers to promote quality member outcomes, optimize member benefits, and promote effective use of resources.* Determines and assesses abnormalities by understanding complex clinical concepts/terms and assessing members’ aggregate symptoms and information.* Assesses member clinical information and recognizes when a member may not be receiving appropriate type, level, or quality of care, e.g, if services are not in line with diagnosis.* Provide consultation to Medical Director on particularly peculiar or complex cases as the nurse deems appropriate.* Collaborates with and provides nursing consultation to Medical Director and/or Provider on select cases, such as cases the nurse deems particularly complex, concerning, or unclear.* Makes recommendations on alternate types, places, or levels of appropriate care by leveraging critical thinking skills and nursing judgment and experience.* Collaborates with case management nurses on discharge planning, ensuring patient has appropriate equipment, environment, and education needed to be safely discharged.