Ciara Medina
Highland,Ca
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Clinical Denial Nurse
Optum
07.2020 - Current
- Clinical Denial Nurse review of approximately 25 denials to ensure denial is consistent with organizational policies and procedures and compliant with state and federal guidelines
- Clinical Denial Nurse scope of work includes authorship and generation of denial letters that meet state, federal, and health plan guidelines
- Writing of denials at appropriate literacy level using letter templates as mandated by regulators
- Able to work independently, as well as work on projects that impact departmental workflows.
Care Manager/TOC Nurse
Epic Management
07.2014 - 07.2020
- Ambulatory Care LVN work with outpatient members, providers and caregivers to facilitate intensive, comprehensive care management, working with chronic or catastrophic cases through care management process according to program guidelines
- Provide healthcare resources, counseling, and on demand information to member’s who have specific chronic condition, coordinate care needs with member and primary care provider, serve as liaison between providers, member’s and care management teams, all interactions are documented and sent to appropriate individuals.
Licensed Vocational Nurse GI
Beaver Medical Group
01.2007 - 01.2014
- Assist with providing quality direct patient care, administered medication, obtained and carried out physician orders, offer exceptional services to patient and families, accurately maintained patients medical history, vital signs, test results, collect specimens, insert and monitor IV therapy and report to physician as needed. Managed incoming calls from patients, updating and filing patients medical records, handling correspondence, scheduling appointments, arrange hospital admissions and laboratory services. Managed approximately 30 incoming calls and faxes per day from patients.
- Promoted patient safety through vigilant monitoring of vital signs and reporting any abnormalities to appropriate healthcare provider promptly.
- Worked with multidisciplinary team to carry out successful treatment plans for diverse acute and chronic conditions.
- Managed patient care through closely monitoring respiration, blood pressure, and blood glucose levels.
- Strengthened infection control measures by strictly following hand hygiene protocols and utilizing personal protective equipment when necessary.
- Fostered positive work environment by collaborating with colleagues, sharing knowledge, and mentoring new nursing staff members.
- Streamlined patient flow in busy clinic setting, ensuring timely access to care for all patients.
- Collaborated with interdisciplinary team members for optimal patient outcomes.
Education
Certificate - IV Therapy And Blood Withdrawal
Prep For Success
Redlands, CA08.2007
Licensed Vocational Nursing -
Summit Career College
Colton, Ca07.2007
Medical Assistant Certification -
San Bernardino Adult School
San Bernardino, Ca2001
Skills
- Highly analytical healthcare professional with 22 years of experience in clinical care, Case Management, leadership and Clinical Denial Nurse
- Working knowledge of guidelines and regulations relevant to Medicare and Medicaid
- Patient care in accordance with applicable standards, policies and procedures
- Excellent observation and good nursing judgment
- Ability to work quickly and safely from one task to another independently and strong attention to detail
- Proficient in documentation, record maintenance to ensure accuracy and patient confidentiality
- Strong medicine, medical terminology and comprehensive writing skills
- Working knowledge of Medicare, DMHC, NCQA, Milliman Care and Health Plan Guidelines
- Case reviews
- Hipaa and Confidentiality
Certification
- Medical Assistant - 2000-2001 San Bernardino Adult School
- Licensed LVN -2005-2007, Summit Career College
- IV Therapy and Blood Withdrawal, 8/3-5 2007, Prep For Success
- BLS Certificate
Timeline
Clinical Denial Nurse
Optum
07.2020 - Current
Care Manager/TOC Nurse
Epic Management
07.2014 - 07.2020
Licensed Vocational Nurse GI
Beaver Medical Group
01.2007 - 01.2014
Certificate - IV Therapy And Blood Withdrawal
Prep For Success
Licensed Vocational Nursing -
Summit Career College
Medical Assistant Certification -
San Bernardino Adult School
Similar Profiles
Samantha MyersSamantha Myers
Insurance Agent at OptumInsurance Agent at Optum
Summer PalmerSummer Palmer
Manager of Clinical Operations at OptumManager of Clinical Operations at Optum
Ashly MillerAshly Miller
Medical Assistant/Phlebotomist at OptumMedical Assistant/Phlebotomist at Optum
Dawnda CookDawnda Cook
Associate Clinical Administrative Coordinator at OptumAssociate Clinical Administrative Coordinator at Optum
Marc FambroMarc Fambro
Security Officer at HOOK PRIVATE SECURITYSecurity Officer at HOOK PRIVATE SECURITY