Katrina Delgado

Background

About Katrina Delgado

Senior Registered Nurse with 15+ years of experience across Utilization Management, Case Management, nursing supervision, and acute care. Extensive background supporting Medicare, Medicaid, and Dual Special Needs Plan populations, with a strong focus on medical necessity review, complex care coordination, and regulatory compliance.Currently serving as a Utilization Management RN with Highmark Health Options and as a Nursing Supervisor in a rehabilitation setting. Selected as a core clinical contributor to the January 2025 launch of Delaware’s Medicare DSNP program and as a clinical tester for the Guiding Care platform, helping tailor systems to Utilization Management workflows and documentation needs.Known for strong clinical judgment, interdisciplinary collaboration, and the ability to manage high-risk, medically complex populations across the full continuum of care. Experienced working with Medical Directors, hospital systems, post-acute providers, and care management teams to support safe transitions, appropriate utilization, and quality outcomes.Core areas of expertise include:Utilization Management | Medical Necessity Review | Medicare & Medicaid | DSNP | InterQual | Care Transitions | Program Implementation | Nursing Leadership | Regulatory Compliance | High-Risk Case Management