ASHA MATHEW
Friendswood,TX
Summary
Dynamic Utilization Review Case Manager at UTMB with expertise in case management and compliance. Proven ability to enhance patient outcomes through effective care coordination and critical thinking. Skilled in documentation and HIPAA compliance, fostering strong relationships with healthcare teams to ensure optimal resource utilization and adherence to medical necessity criteria.
Overview
2026
2026
years of professional experience
Work History
Utilization Review Case Manager
UTMB
07.2015 - Current
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- ensuring the appropriate and efficient utilization of healthcare services for the incarcerated population, aligning with correctional facility policies, regulatory guidelines, and medical necessity criteria.
- Conduct prospective, concurrent, and retrospective reviews of inmate medical records to determine the medical necessity and appropriateness of admissions, continued stays, and resource utilization.
- Apply evidence-based, nationally recognized guidelines such as InterQual criteria and correctional healthcare policies to validate the level of care and ensure compliance with regulatory and reimbursement requirements.
- Collaborate with physicians and other healthcare professionals to ensure complete and accurate documentation that supports the medical necessity of services.
- Pre authorize the procedures, ER visits, inpatient stays.. etc
- Concurrent review for inpatient stay.
- Conduct transfer patients from free world hospitals to prison hospital in Galveston.
RN/Correctional Nurse
UTMB
10.2014 - 08.2015
- Administered medications accurately and safely, reducing medication errors and adverse reactions.
- Enhanced patient satisfaction through effective communication, empathy, and timely response to their needs.
- Collaborated with interdisciplinary teams for comprehensive patient care plans, resulting in better health outcomes.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Improved patient outcomes by providing high-quality nursing care and implementing evidence-based practices.
RN, Medical-Surgical
Hermann Memorial Hospital
07.2009 - 02.2014
- Prioritized critical thinking skills in assessing patient conditions, leading to timely interventions that prevented complications or deterioration of health status.
- Enhanced patient satisfaction by providing compassionate and attentive care to a diverse population of patients.
- Contributed to a positive work environment through effective communication and collaboration with colleagues and supervisors.
- Utilized critical thinking skills to recognize early signs of complications, allowing for timely interventions and preventing adverse outcomes.
- Maintained compliance with regulatory standards by staying current on best practices within the medical-surgical nursing field.
- Improved patient outcomes by consistently implementing evidence-based nursing practices in medical-surgical settings.
- Provided emotional support and education to patients and their families during difficult medical situations, fostering a sense of trust and promoting positive relationships.
- Promoted a culture of safety by adhering to infection control protocols, reducing the incidence of hospital-acquired infections.
- Served as a preceptor for new graduate nurses, facilitating their transition into professional practice and fostering clinical competence.
- Administered medications and treatment to patients and monitored responses.
- Monitored patient vital signs to perform thorough condition assessments.
- Started intravenous fluids, administered medications, and documented patient charts by recording food and fluid output and intake.
- Managed patients' pain by implementing pharmacological and non-pharmacological pain management interventions.
- Performed intravenous therapy procedures and monitored chest tubes.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
- Educated family members and caregivers on patient care instructions.
RN/Registered Nurse, LTAC
Triumph Healthcare
2007 - 2009
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Developed strong relationships with patients'' families, providing emotional support while addressing concerns or questions about care plans.
- Educated patients on disease management and self-care techniques, promoting lifestyle changes for improved health.
- Managed care from admission to discharge.
- Mentored new nursing staff, contributing to a supportive work environment and improved retention rates.
- Assessed patient conditions promptly upon admission to determine appropriate interventions and prioritize care needs.
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Provided direct patient care, stabilized patients, and determined next course of action.
- Monitored patient reactions to drugs and carefully documented findings.
- Participated in professional development opportunities regularly to stay current on best practices in the field of nursing.
- Administered medications and treatments as prescribed by physicians.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Monitored patient reactions after administering medications and IV therapies.
- Observed and documented patient factors such as diets, physical activity levels, and behaviors to understand conditions and effectively modify treatment plans.
RN, Medical-Surgical
Clear Lake Regional Medical Center
2004 - 2007
- Conducted comprehensive patient assessments, identifying pertinent data that informed care plan development and intervention implementation.
- Actively participated in quality improvement initiatives aimed at optimizing patient care delivery within the medical-surgical setting.
- Demonstrated adaptability when reassigned to different units or working with diverse populations while maintaining high levels of quality care provision.
- Monitored hemodynamic variances to identify signs of life-threatening complications.
- Performed emergency medical procedures such as BLS, ACLS and other condition stabilizing interventions.
- Managed patients recovering from medical or surgical procedures.
- Implemented care plans for patient treatment after assessing physician medical regimens.
LVN/Jail Nurse
Harris County Sheriff's Department
2002 - 2004
- Managed patient care through closely monitoring respiration, blood pressure, and blood glucose levels.
- Prevented medication errors by meticulously reviewing physician orders and administering medications as prescribed.
- Worked with multidisciplinary team to carry out successful treatment plans for diverse acute and chronic conditions.
- Cared for wounds, provided treatments, and assisted with procedures.
- Assessed patients' temperature, pulse, and blood pressure and recorded in electronic medical records.
- Used aseptic techniques to provide sterilized wound care and dressing applications.
LVN/LTAC
Corner Stone Long Term Acute Care Hospital
2001 - 2002
- Promoted patient safety through vigilant monitoring of vital signs and reporting any abnormalities to the appropriate healthcare provider promptly.
- Assisted with admissions, appointments, transfers, and discharges.
- Facilitated effective communication between patients, families, and healthcare providers to ensure continuity of care during transitions between facilities or levels of care.
- Advocated for patients'' needs effectively, working closely with healthcare providers to develop and implement appropriate care plans.
- Documented accurate and complete patient information to address patient problems and expected outcomes.
- Improved patient satisfaction by providing compassionate and attentive care.
- Documented patient vitals, behaviors, and conditions to communicate concerns to supervising nurse.
- Responded to patient requests with appropriate clinical and personal assistance.
- Administered controlled narcotics, inserted IVs, and performed catheterizations.
LVN/Correctional Nurse
UTMB/TDCJ
1999 - 2001
- Evaluated patients to identify and address wounds, behavioral concerns, and medically relevant symptoms.
- Provided excellent wound care management, resulting in faster healing times for patients with complex wounds.
- Delivered updates in patient status to charge nurse, recording changes in medical records.
- Obtained patient vital signs and input/output measurements from inpatients.
- Administered medications and injections to patients.
- Administered medications and treatment to patients and monitored responses.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
LVN Charge Nurse
Village on the Creek Skilled Nursing Facility
1998 - 1999
- Oversaw patient conditions, administered medicine, performed interventions and took detailed records.
- Promoted continuity of care by maintaining comprehensive medical records and updating physicians on significant changes in patients'' conditions.
- Championed infection control practices within the unit by strictly adhering to guidelines and educating staff on proper procedures.
- Cultivated strong working relationships with physicians by maintaining open communication, providing timely updates on patients'' status, and actively participating in care coordination efforts.
- Managed patient caseloads effectively by prioritizing needs, delegating tasks appropriately, and collaborating with healthcare professionals.
Education
Associate of Science - Nursing
Excelsior College
Albany, NYDiploma - Vocational Nursing
Brazosport College
Lake Jackson, TXSkills
- Problem-solving
- Case management
- Time management
- Case documentation
- Active listening
- Organization and multitasking
- Documentation and reporting
- Relationship building
- Decision-making
- Conflict resolution
- Positive attitude
- Email and telephone etiquette
- Care coordination
- Critical thinking
- Documentation proficiency
- Data entry and analysis
- Utilization review
- Utilization management
- Indirect patient care
- Quality assurance controls
- Family education
- EMR / EHR
- HIPAA compliance
- Verbal and written communication
- Risk assessment
- Empathy and compassion
- Utilization criteria
- MS office
- Patient support
- Patient assessment
Timeline
Utilization Review Case Manager
UTMB
07.2015 - Current
RN/Correctional Nurse
UTMB
10.2014 - 08.2015
RN, Medical-Surgical
Hermann Memorial Hospital
07.2009 - 02.2014
RN/Registered Nurse, LTAC
Triumph Healthcare
2007 - 2009
RN, Medical-Surgical
Clear Lake Regional Medical Center
2004 - 2007
LVN/Jail Nurse
Harris County Sheriff's Department
2002 - 2004
LVN/LTAC
Corner Stone Long Term Acute Care Hospital
2001 - 2002
LVN/Correctional Nurse
UTMB/TDCJ
1999 - 2001
LVN Charge Nurse
Village on the Creek Skilled Nursing Facility
1998 - 1999
Associate of Science - Nursing
Excelsior College
Diploma - Vocational Nursing
Brazosport College
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