Angel C. Moreno-Cruz, BSN, RN, CBE
Hialeah,Florida
Summary
Skilled nursing professional with strong background in patient care coordination and healthcare management. Demonstrates expertise in clinical assessment, discharge planning, and patient advocacy. Known for fostering team collaboration, adapting to evolving needs, and delivering meaningful outcomes. Equipped with excellent communication skills, critical thinking, and ability to navigate complex healthcare systems.
Healthcare professional with substantial experience in utilization review and patient care management. Known for precision in evaluating patient treatment plans and making critical decisions to optimize resource use. Valued team collaborator with focus on achieving impactful results and adapting to dynamic healthcare environments.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Registered Nurse Case Manager
Jackson Memorial Hospital
05.2022 - Current
- Administered medications and treatments as prescribed by physicians.
- Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
- Educated and supported home healthcare providers with training, guidance, mentoring and resources required to achieve objectives."
Case Manager/ Utilization Review
Conifer Health Solutions
01.2016 - 12.2018
- Based out of Tampa FL. Working from home. Evaluated the progress of each patient and provided updates to insurance providers. Performed utilization reviews in accordance with state and federal regulations.
Nurse Case Manager for CMS and Utilization Review
Centene Sunshine Healthcare
01.2020 - 05.2022
- Optimized resource utilization by identifying opportunities for cost containment without compromising care quality.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Promoted patient education by providing resources and information on treatment options and healthcare rights.
- Collaborated with physicians to clarify treatment plans, ensuring alignment with evidence-based practices.
- Gathered and recorded patient health information and data to assess, identify and manage characteristics that affect care outcome.
- Observed, monitored, and reported changes in patient condition to supervising RN or physician in accordance with policies and procedures of medical facility.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
Case Manager/Utilization Review Nurse
Conifer Health Solutions LLC
01.2016 - 12.2018
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Enhanced the efficiency of the utilization review process by collaborating with interdisciplinary teams and streamlining communication channels.
- Served as a liaison between healthcare providers, insurance companies, and patients for efficient resolution of coverage issues or denials following a utilization review assessment.
- Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
Registered Labor & Delivery Nurse, OR Nurse and Childbirth Instructor
Palmetto General Hospital
08.2008 - 12.2016
- Care for antepartum, intrapartum and postpartum patients in Labor & Delivery Unit. Perform and assist admissions, discharges, triages, or recovery from Cesarean Section. Perform clinical tasks according to hospital policies. Assess patient status and notify physicians of clinical changes. Interact with departments regarding patient care. Educate patients/families on health care needs, conditions, options etc. Maintain patient charts and confidential files. Trained to perform the scrub tech function in the Operating Room cesarean section procedures. Teach expecting parents in child-birthing and breastfeeding classes once a month at two different Tenet Hospitals. As an operating nurse I monitored, recorded and communicated patient’s condition during pre-operative, intra-operative, and PACU. I also trained to perform the scrub tech function in the operating room doing cesarean sections and other procedures. Taught expecting parents in child-birthing and breastfeeding classes once a month at two different Tenet Hospitals.
Adjunct Clinical and Lecture Instructor
Florida National University
05.2015 - 12.2015
- Taught multiple courses in the university Clinical Nursing Program to undergraduate students training to become nurses. Exacted high standards due to firm belief that excellence in care is mandated for patient safety in the medical field. Failed students, who did not meet standards of care, provided both lecture-based and clinical instruction to students in patient care practices, trained students on how to work as part of the medical team in hospital settings. Designed and administered written examinations. Graded completed tests and recorded grades in the University’s secure electronic grading system. Observed clinical students carefully during practicums and rounds, and wrote recommendations for exceptional students.
Education
Master of Science - Education
Chamberlain University
Chicago, IL07-2026
Bachelor of Science - Nursing
Chamberlain University
Chicago, IL08-2018
Associate Arts - undefined
Miami Dade College
Miami, Florida12.2010
Associate Science - Registered Nurse
Miami Dade College
Miami, Florida04.2007
Skills
- Front office administration
- Skilled in various EMR programs and Microsoft applications
- Case management
- Discharge planning
- Staff education and training
- Multitasking
- Strong organizational abilities
- Skilled in English and Spanish communication
Certification
- Licensed Registered Nurse - since 2007
- BLS 2008, ACLS 2008, NRP 2009, S.T.A.B.L.E.2011, Advance Fetal Heart Monitoring and Breastfeeding 2012
- Certification by the from Healthy Start Coalition as Child Birthing Educator in 2009.
Timeline
Registered Nurse Case Manager
Jackson Memorial Hospital
05.2022 - Current
Nurse Case Manager for CMS and Utilization Review
Centene Sunshine Healthcare
01.2020 - 05.2022
Case Manager/ Utilization Review
Conifer Health Solutions
01.2016 - 12.2018
Case Manager/Utilization Review Nurse
Conifer Health Solutions LLC
01.2016 - 12.2018
Adjunct Clinical and Lecture Instructor
Florida National University
05.2015 - 12.2015
Registered Labor & Delivery Nurse, OR Nurse and Childbirth Instructor
Palmetto General Hospital
08.2008 - 12.2016
Associate Arts - undefined
Miami Dade College
Associate Science - Registered Nurse
Miami Dade College
Master of Science - Education
Chamberlain University
Bachelor of Science - Nursing
Chamberlain University
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