Summary
Overview
Work History
Education
Skills
Timeline
Receptionist
Catherine Carrasco

Catherine Carrasco

San Antonio,Tx.

Summary

Utilization Review Nurse with desire to take on new challenges. Strong work ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills with talents in continuous assessments and clinical records oversight. Highly-motivated individual with 18 years in the nursing field, seeking opportunity to join new company that appreciates attention to detail and exemplary clinical review skills.

Overview

18
18
years of professional experience

Work History

Concurrent Review RN/Utilization Management Nurse

Centene Corporation
Austin, TX
06.2022 - Current
  • Review medical records, treatment plans and patient progress to determine the appropriateness and necessity of ongoing hospitalization and treatment within 24 hour TAT (Turnaround time).
  • Experience with performing retrospective inpatient authorizations.
  • Perform thorough clinical assessments/reviews for the purpose of evaluating the utilization of healthcare resources and services to ensure they meet the patient's needs and are cost-effective.
  • Maintain regular communication with healthcare providers, case managers and healthcare facilities to discuss patient status, ongoing treatment plans and potential discharge options.
  • Proficient in utilizing the InterQual program for utilization management and clinical decision support.
  • Proficient in utilizing the Trucare program for utilization management.
  • Proficient in working with APA DRG codes for accurate healthcare billing and data analysis.
  • Proficient in recognizing cases that do no meet InterQual Standards and effectively coordinating provider reviews to ensure appropriate patient care.
  • Proficient in applying InterQual Guidelines to determine the appropriateness and necessity of SNF, Rehab and LTAC authorizations.

Registered Nurse

Methodist Healthcare System-Neonatal Intensive Care
San Antonio, Tx
06.2006 - 06.2022
  • Manage care of the neonatal population in conjunction with practitioners and neonatologists to determine the best positive outcome for both patients and their families
  • Manage care to include but not limited to administration of medication-appropriate dosages, changes in patient status-vitals, signs/symptoms of distress as determined by age of neonate, discharge planning
  • Knowledge of the disease process to be able to help parents not only cope but thrive in understanding the situation/status of their loved one
  • Recommendations/Requests for treatments from practitioners/doctors when deemed appropriate.

Nurse Extern II

Methodist Healthcare System
San Antonio, Tx
11.2003 - 04.2006
  • Stimulate critical thinking, observe treatments/procedures assisting as directed by registered nurse
  • Develop communication skills in working with physicians, nursing staff and ancillary departments.

Education

Graduated Nursing Diploma Program -

Baptist School of Health Professions
04.2006

Skills

  • Patient Management
  • Care Planning
  • Medical assessment
  • Coordinating referrals
  • Managing deadlines
  • Utilization of InterQual Program
  • Discharge Planning

Timeline

Concurrent Review RN/Utilization Management Nurse

Centene Corporation
06.2022 - Current

Registered Nurse

Methodist Healthcare System-Neonatal Intensive Care
06.2006 - 06.2022

Nurse Extern II

Methodist Healthcare System
11.2003 - 04.2006

Graduated Nursing Diploma Program -

Baptist School of Health Professions

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Catherine Carrasco