Registered Nurse
Alida Gonzales
UnitedHealthcare
Claremore,OK
1
Certification
27
Years of experience
Knowledgeable Registered Nurse with strong background in clinical review and patient care coordination with 28 years of diverse experience in direct patient care, staff supervision and department operations. Skilled at multitasking and prioritizing patient needs and daily assignments. Offering expertise with Clinical Review specialty.
Work History
Clinical Review Nurse
1 Year- Interpreted clinical documentation to support appropriate utilization management decisions and care recommendations.
- Reviewed medical necessity for prior authorization requests using evidence-based clinical criteria and plan policies.
- Communicated determination outcomes clearly with providers, members, and internal case management teams.
- Documented review findings accurately in clinical systems to maintain compliance and audit readiness.
- Escalated complex cases for physician review when clinical information required additional assessment.
- Maximized efficiency within the department by organizing workload according to priority level, ensuring deadlines were met consistently.
Registered Nurse, Medical-Surgical
6 Months- Assessed medical-surgical patients, prioritized care needs, and identified changes in condition for timely intervention.
- Educated patients and families on diagnoses, medications, discharge instructions, and self-care expectations.
- Implemented infection control and safety protocols to reduce risk and maintain clean, compliant care environments.
- Performed accurate assessments of patients'' conditions and communicated updates to physicians promptly.
- Administered medications and monitored responses, maintaining compliance with physician orders and nursing standards.
- Documented assessments, interventions, and patient responses in electronic health records with accuracy and consistency.
Registered Nurse, Utilization Review Department
11 Years 7 Months- Reviewed admissions for medical necessity using InterQual criteria, ensuring compliance and appropriate care
- Utilized InterQual and MCG criteria for admissions review
- Sent clinical information via fax or uploaded on insurer platforms for admission
- Prepared monthly utilization review report and communicated findings in medical executive meetings to inform decision-making
- Developed appeals program for denials, enhancing process for addressing claims and improving patient access
- Served as discharge planner during staffing vacancy
Registered Nurse, House Supervisor
4 Years 7 Months- Coordinated staffing schedules to maintain adequate coverage for all shifts
- Acted as a liaison between nursing staff and upper management, conveying concerns and feedback from both parties.
- Mentored junior nurses/staff members by providing guidance/support during challenging situations
- Conducted regular rounds on nursing units to evaluate staffing needs and provide support as needed
- Responded to emergencies and crisis situations, providing guidance and support to staff members as needed
- Monitored patient flow throughout the facility, identifying bottlenecks and implementing solutions to improve efficiency
Registered Nurse, Emergency Department
7 Years 7 Months- Triaged and assessed patients of all ages
- Prepared and administered medications by all routes
- Started and managed intravenous lines
- Administered fluids and blood to ensure patient stability and recovery
- Administered respiratory treatments
- Placed NG tubes, performed gastric lavage
- Operated equipment such as IV pumps, EKG machines, cardiac monitors, defibrillator/AED
- Operated IV pumps, EKG machines, cardiac monitors, defibrillator/AED to support critical patient care
- Employee of the Month in 2004
Licensed Vocational Nurse, Shift Coordinator
1 Year 6 Months- Conducted physical and behavioral health assessments for weekly and monthly summaries, ensuring comprehensive patient care
- Provided wound care treatments to patients
- Wound care treatments
- Assisted and supervised nurses' aides and technicians in providing activities of daily living (ADLs), enhancing patient support
- Volunteered to fill staffing shortages during critical times
- Recognized as Employee of the Quarter for outstanding performance
Education
Bachelor’s degree - nursing
Associate’s degree - nursing
Skills
Utilization management
Decision analysis
Adaptability
Clinical judgment
Decision-making
Quality enhancement
Patient confidentiality
HIPAA compliance
Certification
- Licensed Registered Nurse - Multistate
- BLS
Timeline
Clinical Review Nurse
UnitedHealthcare
2025.11 - 2026.11Read More
Registered Nurse, Medical-Surgical
Oklahoma State University-Tulsa
2025.05 - 2025.11Read More
Registered Nurse, Utilization Review Department
Claremore Indian Hospital-Claremore
2013.09 - 2025.04Read More
Registered Nurse, House Supervisor
Claremore Indian Hospital-Claremore
2009.02 - 2013.09Read More
Registered Nurse, Emergency Department
Claremore Indian Hospital-Claremore
2001.07 - 2009.02Read More
Licensed Vocational Nurse, Shift Coordinator
Crestwood Behavioral Health-Redding
1999.10 - 2001.04Read More
Rogers State University-Claremore
Associate’s degree from nursing
Read More
Oklahoma Wesleyan University-Bartlesville
Bachelor’s degree from nursing
Read More