Nicole Busch
Utilization Review Nurse @Bluecross Blueshield Health Insurance
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WORK HISTORY
Utilization Review Nurse @Bluecross Blueshield Health Insurance
Downers Grove, IL, US
Conduct comprehensive clinical reviews to assess the medical necessity and appropriateness of inpatient, outpatient, surgical, DME, pharmacy, and office-based services.• Support a specialized population (Special Needs Pediatrics), ensuring care plans align with clinical guidelines, regulatory requirements, and best practices.• Collaborate with care coordination teams, providers, and interdisciplinary partners to facilitate appropriate, high-quality patient care.• Utilize healthcare management platforms (Guiding Care, Smart UM) to document reviews, support clinical decision-making, and maintain compliance.• Manage a daily caseload of up to 15 complex cases, balancing accuracy, timeliness, and quality outcomes.
EDUCATION
Marquette University
Master's degree, Nursing
Marquette University
MSN, Registered Nursing/Registered Nurse
Eckerd College
Undergraduate, Liberal Arts and Sciences/Liberal Studies
Marquette University
Undergraduate in Business, Marketing
ABOUT NICOLE BUSCH
Registered Nurse with nearly 10 years of experience across acute care, ambulatory care, and procedural settings within large health systems. Strong background in care coordination, quality improvement, and interdisciplinary collaboration. Experienced in managing complex patient populations, supporting physician workflows, and improving care delivery through efficient clinical processes. Brings a patient-centered approach with a strong foundation in clinical judgment, documentation, and operational efficiency.
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