Summary
Overview
Work History
Education
Skills
Timeline
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Allison Gonzalez

Waco

Summary

Dynamic RN Utilization Review Nurse with a proven track record at United Healthcare Group, excelling in discharge planning and patient management. Expert in coordinating complex care plans and ensuring compliance with CMS regulations. Strong clinical judgment and effective team coordination have led to improved health outcomes for high-risk patients.

Overview

15
15
years of professional experience

Work History

RN Utilization Review Nurse/Case Manager

United Healthcare Group
12.2021 - Current
  • Collaborate with interdisciplinary teams for comprehensive patient care plans, resulting in better health outcomes.
  • Coordinate discharge planning efforts with social workers, case managers, and other multidisciplinary team members for smooth transitions post hospitalization.
  • Manage complex cases of high risk patients, ensuring optimal treatment plans were executed effectively.
  • Ensured compliance with CMS regulations and standards by maintaining accurate documentation of all utilization review activities.
  • Performed prior authorization review of services requiring notification.

Utilization Review Nurse

Ascension Providence Hospital-DePaul
07.2019 - 12.2021
  • Served as a vital liaison between patients, healthcare providers, and insurance companies, fostering effective communication and coordination among all parties involved in the care process.
  • Obtained authorizations from multiple insurance carriers for mental health treatment.
  • Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
  • Performed prior authorization review of services requiring notification.

Admissions Coordinator/PPS Coordinator

Baylor Scott & White Medical Center - Hillcrest
07.2010 - 07.2019
  • Assisted in patient admission process based on federal and state laws.
  • Handled inquiries from patient's, families and referral sources to provide detailed information regarding admissions process and criteria for Acute Inpatient Rehab.
  • Worked with multidisciplinary teams to improve clinical documentation and accountability.
  • Managed PPS/PAI data and transmitted to CMS

Education

Associate of Science - Nursing

McLennan Community College
Waco, TX
07-2004

Skills

  • Discharge planning
  • Quality improvement
  • Patient assessments
  • Team coordination
  • Strong clinical judgment
  • Patient management
  • Care planning
  • Case management
  • High level of autonomy
  • EMR systems
  • Complex Problem-solving

Timeline

RN Utilization Review Nurse/Case Manager

United Healthcare Group
12.2021 - Current

Utilization Review Nurse

Ascension Providence Hospital-DePaul
07.2019 - 12.2021

Admissions Coordinator/PPS Coordinator

Baylor Scott & White Medical Center - Hillcrest
07.2010 - 07.2019

Associate of Science - Nursing

McLennan Community College

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