Patricia Kelly, RN, BSN, CCM, CLCP

Over 40+ years of nursing experience including strong background in clinical practice (Med/Surg, ICU and ED) as well as project management. Proven track record in the life care planning, care management, utilization review managed care and business planning industry. Diverse leadership expertise (Director of CM and UM) managing people and processes. Subject matter expert adept in medical case review, program development, appeals, utilization review, case management and disease management.
Extensive knowledge of both Medicare and Medicaid, Centers for Medicare/Medicaid Services (CMS) and National Committee for Quality Assurance (NCQA) regulations and guidelines as it applies to all aspects of clinical care and treatment with a focus on Utilization management, Care Management, Quality Assurance and Appeals/Grievances. Experienced in the use and application of clinical care guidelines including Milliman and InterQual programs.