Microsoft Excel
Cassandra Wan
San Jose,CA
Summary
More than 9 years of nursing experience, utilization review and discharge planning expertise. Analytical and strategic nurse knowledgeable in root-cause analysis and effective stakeholder engagement. Consistently proves to maintain calm demeanor under pressure and ability to tactfully manage high-stress situations. Known for having great rapport with providers and insurance carriers through empathetic communication and respectful attitude.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Utilization Management & Discharge Planning Nurse
Santa Clara Family Health Plan
2022.10 - Current
- Review upwards of 15 cases daily for initial or concurrent stay using MCG Guidelines in members admitted in inpatient, outpatient, LTAC, and skilled nursing facility
- Learned and applied DHCS TAG to review 20+ cases in less than one week for delegate oversight to meet company deadline for annual DHCS Medi-Cal Audit
- Complete review of medical necessity for 10+ prior authorization cases daily using DHCS Medi-Cal Manuals & APLs, Medicare LCD/NCD, and Member EOB maintaining company compliance with regulatory Turn Around Times
Public Health Nurse
County of Santa Clara Public Health Department
2021.06 - 2022.05
- Improved community health by conducting assessments, identifying needs, and implementing targeted interventions for at risk babies and toddlers from birth to 5 years old
- Lead team in creating new employee training materials, written standard operating procedures, and tip sheets for external referral workflows
Rehabilitation Case Manager
Santa Clara Valley Medical Center
2019.11 - 2021.05
- Obtained pre-authorization and maintained concurrent authorizations with HMO, PPO, Managed Medi-Cal and Medicare Plans for up to 15+ patients daily
- Maintained assignment and provided float coverage with average caseload of 12 patients through development and implementation of comprehensive discharge plans to local, and out of county and state locations
- Successfully allocated 5 iPads and standing equipment to implement video visits in 2020 during COVID-19 pandemic, leading to improved patient and caregiver participation and outcomes
Registered Nurse
Santa Clara Valley Medical Center
2015.06 - 2019.11
- Collaborated with interdisciplinary teams to develop comprehensive treatment plans for complex patients with stroke and brain injuries.
- Provided training and mentorship of new nursing staff members, contributing to positive work environment and adhering to standards of high-quality patient care
- Participated in Shared Leadership Committee and Fall Committee to create unit-based policies, conceptualize solutions for ongoing unit concerns, and efforts to improve workflow efficiency.
Education
Bachelor of Science in Nursing -
San Jose State University
San Jose, CA12.2014
Skills
- Utilization review
- InterQual
- Milliman Guidelines
- Medicaid & Medicare knowledge
- Regulatory Requirements
- Case Management
- Efficiency Improvement
- Process improvement strategies
- Data Analysis
- Microsoft Office
- Computer Skills
Leadership Experience
- Member, Shared Governance of Brain Injury & Stroke Rehabilitation Unit, 10/01/19, 11/01/19
- Member, Acting Chair, Fall Committee of Brain Injury & Stroke Rehabilitation Unit, 08/01/16, 11/01/19
- Secretary, Vice President, Public Health Nursing Club at San Jose State University, 05/01/12, 05/01/13
Personal Information
Title: RN, BSN
Software
EPIC Systems
Certification
- Data Science Orientation Training - Nov 2023
Timeline
Utilization Management & Discharge Planning Nurse
Santa Clara Family Health Plan
2022.10 - Current
Public Health Nurse
County of Santa Clara Public Health Department
2021.06 - 2022.05
Rehabilitation Case Manager
Santa Clara Valley Medical Center
2019.11 - 2021.05
Registered Nurse
Santa Clara Valley Medical Center
2015.06 - 2019.11
Bachelor of Science in Nursing -
San Jose State University
- Data Science Orientation Training - Nov 2023
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