Christine Joy Tayamen
Knoxville
Summary
With nearly 6 years of comprehensive nursing experience, including direct Utilization Review and clinical leadership roles, Christine Tayamen, BSN, RN, excels in evaluating patient needs and optimizing care delivery. She possesses a proven ability to interpret medical necessity criteria, ensure regulatory compliance, and facilitate appropriate patient status determinations. A skilled collaborator and educator, she is adept at maintaining documentation accuracy and contributing to process improvement within complex healthcare systems.
Overview
17
17
years of professional experience
Work History
Registered Nurse/House Supervisor
National Healthcare Corporation (NHC)
Knoxville
09.2022 - Current
- Deliver integrated nursing knowledge, process admissions, administer treatments, and document symptoms and progress.
- Evaluate physical, psychosocial, and environmental factors to identify and achieve patient health goals.
- Work closely with doctors, therapists, and LPNs/aides to optimize rehabilitation and personal care.
- Instruct patients/caregivers on disease management and act as an advocate for patient rights and responsibilities.
- Adjust nursing schedules, call in extra help, and reassigns staff across units to cover absences and maintain safe ratios.
- Serve as the primary facility administration representative when senior leadership is off-duty.
- Guided newly hired nurses to develop clinical skills and build confidence in providing patient care.
Pre-Service Review Nurse
Optum (Unitedhealth Care)
Quezon
07.2021 - 08.2022
- Evaluate and assess each request verifying eligibility and specific product.
- Determine benefit level based on site of service.
- Utilize written criteria to approve, pend or send the case to the medical director for review - Utilization review experience using the Optum/Inter Qual product.
- Pend cases by documenting in the claim's payment system, contacting the provider for the necessary information via fax and / or phone and sending a letter to the member to alert them of the pending decision.
- Maintain 100% accuracy of clinical review case notes in Facets.
- Maintain productivity standards and maintain compliance with all regulatory agencies including NCQA, DOL, DOI for each state, Medicaid, CMS and OPM.
- Maintain 100% accuracy in summarizing cases for the Medical Director to review using appropriate protocols-based members clinical and benefit information.
- Maintain compliance with turnaround times based on the member's product, the type of request and the specific regulatory agency.
Senior Quality Assurance Analyst/Scrum Master
Infor PSSC, Inc.
Bonifacio Global City (BGC)
11.2014 - 12.2020
- Ensures adequate product testing prior to release based on the development lifecycle.
- Defect Management and Reporting.
- Provides reports on test results and status.
- Defines and documents QA/Testing methodologies and processes.
- Analyzes current testing mechanisms to determine areas of improvement.
- Mentors quality analysts on methodologies, technologies and problem-solving techniques.
- Partner with the Process Management Group to achieve process improvement goals.
- Assigns work to and manages test teams.
- Eliminates impediments.
- Plans and facilitates Sprint Planning.
- Maintains Automation Framework.
- Identifies functionalities to automate.
- Designs and develops reusable methods.
- Designs and develops new automated test scripts.
- Executes test suites and reports test status.
Clinical Systems Analyst
St. Luke's Medical Center - Global City
Taguig
01.2012 - 01.2014
- Evaluates computerization requirements of specific users and in accordance with the requirements, designs the computer system, formulates programming specifications and timetable.
- Translates IT software project plans into tangible deliverable.
- Plans and directs the activities of programmers under his/her jurisdiction toward fulfilling project objectives.
- Performs and evaluates risk analysis for all application systems under development and existing systems being maintained.
- Employs tools and techniques of systems analysis and design which enables adequate documentation of the system at each stage of the development project.
- Recommends process that will enhance the user-friendliness of present applications.
- Coordinates with users and project sponsors regarding the requirements at each stage of the software projects.
- Serves as internal resource person to programmers on the manner of implementing systems.
Medical-Surgical Nurse
St. Luke's Medical Center - Global City
Taguig
01.2009 - 01.2012
- Conducts an individualized patient assessment, prioritizing the data collection based on the adult or elderly patient's immediate condition or needs within timeframe specified by the hospital's policies, procedures and protocol.
- Conducted ongoing assessments based on adult or elderly patient's condition, adjusting care priorities in accordance with hospital policies and protocols.
- Documented patient assessment findings and responses to nursing interventions, tracking progress towards resolution of identified health issues.
- Developed individualized care plans for adult or elderly patients in collaboration with healthcare team members to ensure comprehensive patient management.
- Administered treatments ordered by physician accurately and promptly.
- Performs therapeutic nursing interventions as established by individualized plan of care for the adult or elderly patient and his/her family.
- Provides individualized patient/family education customized to the adult or elderly patient and his/her family.
- Initiates emergency resuscitative measures according to adult resuscitation protocol.
- Provides care in a non-judgmental, non-discriminatory manner that is sensitive to the adult or elderly patient's and family's diversity, preserving their autonomy, dignity and rights.
- Maintains confidentiality in matters related to patient, family and client facility staff.
- Reports patient condition to appropriate personnel during each shift.
Education
Bachelor's Degree - Nursing
University of Santo Tomas
Manila, Philippines03-2006
High School -
School of Saint Anthony
Quezon City, Philippines03-2002
Skills
- Patient management
- Utilization management
- Quality Assurance
- MS Office Suite (Excel, Word, OneNote, Project, Powerpoint, Teams)
Cellphone Number
865-393-1343
Other Technical Skills
- MS Word
- MS Excel
- MS Project
- MS OneNote
- MS Outlook
- MS Powerpoint
- MS Teams
Nursing Licenses
- California, 95442895, 12/31/27
- Tennessee, 256489, 11/30/26
- New York, 816683, 10/31/26
Languages
English
Professional
Tagalog
Professional
Timeline
Registered Nurse/House Supervisor
National Healthcare Corporation (NHC)
09.2022 - Current
Pre-Service Review Nurse
Optum (Unitedhealth Care)
07.2021 - 08.2022
Senior Quality Assurance Analyst/Scrum Master
Infor PSSC, Inc.
11.2014 - 12.2020
Clinical Systems Analyst
St. Luke's Medical Center - Global City
01.2012 - 01.2014
Medical-Surgical Nurse
St. Luke's Medical Center - Global City
01.2009 - 01.2012
Bachelor's Degree - Nursing
University of Santo Tomas
High School -
School of Saint Anthony