CHEYENNE MORENO PEREZ
Schererville,IN
Summary
Detail-oriented registered nurse with 5+ years of clinical experience and current experience in utilization/benefit management. Skilled in medical necessity review, clinical documentation analysis, and application fo evidence-based criteria to determine appropriate level of care. Experienced in interdisciplinary collaboration, regulatory compliance, and care coordination. Seeking a remote Utilization Review/Utilization Management Nurse position where strong clinical judgment and analytical skills can support cost-effective, quality patient outcomes.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Registered Nurse
Franciscan Health Dyer
01.2024 - Current
- Conduct comprehensive clinical reviews for 20-30+ cases weekly to determine medical necessity and appropriate level of care using established clinical criteria and payer guidelines
- Analyze complex medical records to support benefit determination, reducing incomplete documentation submissions by an estimated 25%
- Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
- Review medical records and interpret clinical data to support utilization/benefit determinations
- Collaborate with providers, case managers, and interdisciplinary teams to ensure appropriate resource utilization, facilitate timely discharge planning, contributing to reduced avoidable length of stay
- Navigate through multiple system applications as well as outreach to internal department or providers
- Evaluate inpatient and outpatient services for compliance with regulatory and payer requirements as well as develop care plans to support optimal outcomes while maintaining cost-effective care delivery
Registered Nurse
Methodist Northlake Hospital
06.2023 - 01.2024
- Managed a 6:1 patient assignment while maintaining 100% compliance with documentation standards
- Fostered strong communication skills, providing necessary education to first-time parents, and building interpersonal relationships between patients and healthcare providers.
- Partnered with internal multidisciplinary teams to help maximize patient health outcomes and facilitate quicker response times
- Independently coordinates the clinical resolution with clinician/MD support
- Performed detailed patient assessments and documented clinical findings to support accurate medical records and support reimbursement/continuity of care
- Managed patient assignments while maintaining compliance with hospital and regulatory standards
Nursing Extern
Methodist Northlake Hospital
07.2022 - 06.2023
- Assisted with admissions and clinical documentation review for high-volume acute care cases
- Ensure appropriate utilities/products were available upon request in emergency scenarios
- Improved efficiency of routine assessments and contributed to timely care transitions
- Provided support which lead to strengthen health transitions in my patients
- Maintained meticulous chart review, records, and documentation to aid in compliance standards and accuracy
- Supported emergency response scenarios, ensuring resource availability and clinical readiness
Nurse Fellow
Community Hospital
05.2020 - 07.2022
- Managing 8-12: 1 caseload, delivering quality care in different environments based on each unit needs
- Adhere to company policies regarding confidentiality to protect member information and compliance regulations
- Maintained strict HIPAA compliance and adherence to institutional regulatory standards
- Collaborated with healthcare teams to support quality patient outcomes.
- Monitors member/client progress toward desired outcomes through assessment and evaluation while updating care plans accordingly
- Provided cross-coverage support to improve workflow efficiency during high census periods
Education
Bachelor of Science Nursing - Minor in Psychology
Purdue University Northwest
05-2023
Skills
- Utilization Review (Concurrent & Retrospective)
- Medical Necessity & Level of Care Determination
- Clinical Documentation Analysis
- Denial Prevention & Appeal Support
- Care Coordination & Discharge Planning
- Electronic Medical Records (EMR) Navigation & Multisystem Workflow
- HIPAA Compliance
Certification
Indiana State Board of Nursing, July 2023
Timeline
Registered Nurse
Franciscan Health Dyer
01.2024 - Current
Registered Nurse
Methodist Northlake Hospital
06.2023 - 01.2024
Nursing Extern
Methodist Northlake Hospital
07.2022 - 06.2023
Nurse Fellow
Community Hospital
05.2020 - 07.2022
Bachelor of Science Nursing - Minor in Psychology
Purdue University Northwest