Claurenciana Abad
Lakewood
Summary
Experienced healthcare professional with a strong background in utilization review and medical necessity assessments. Skilled in developing care plans and collaborating with interdisciplinary teams to ensure compliance with health regulations and enhance patient care quality.
Overview
9
9
years of professional experience
Work History
Home Care Registered Nurse
Towne Nursing
07.2022 - Current
- Administered patient assessments and developed personalized care plans to meet individual health needs.
- Collaborated with interdisciplinary teams to enhance patient outcomes and streamline care delivery.
- Monitored vital signs and documented changes in patient conditions, ensuring timely interventions.
- Educated patients and families on health management strategies, promoting self-care practices.
- Implemented infection control protocols, maintaining safety standards within home environments.
- Mentored junior nursing staff, providing guidance on best practices and care techniques.
- Administered medications and oversaw activities of daily living such as bathing, hygiene, and ambulation.
- Coordinated and collaborated with various multidisciplinary teams to coordinate care and promote patient safety and health.
- Developed strong rapport with patients and families, fostering trust in the delivery of high-quality care.
Utilization Review Nurse (part Time)
Genex
12.2022 - 12.2023
- Conducted comprehensive reviews of patient medical records to ensure compliance with utilization management criteria.
- Collaborated with healthcare teams to assess and improve patient care plans based on utilization guidelines.
- Supported clinical staff by providing education on utilization review processes and best practices.
- Participated in interdisciplinary meetings to discuss case findings and enhance patient advocacy initiatives.
- Utilized clinical guidelines and protocols to evaluate treatment effectiveness and appropriateness.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
Workers Compensation Utilization Review Nurse
Shearwater Health
06.2021 - 06.2022
- Led utilization review processes to ensure compliance with healthcare regulations and policies.
- Collaborated with interdisciplinary teams to develop and implement care plans for patients.
- Evaluated clinical information to determine medical necessity for procedures and admissions.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Conducted thorough evaluations of medical necessity for procedures, leading to optimal resource utilization.
- Evaluated patient histories, complaints, and current symptoms.
Utilization Review Nurse
EXL Service
02.2017 - 04.2021
- Monitored trends in service utilization to recommend adjustments for improved outcomes and efficiency.
- Performed prior authorization review of services requiring notification.
- Improved patient care quality by conducting thorough utilization reviews and making recommendations for optimal treatment plans
- Conducted comprehensive reviews of patient medical records to ensure compliance with utilization management criteria.
- Collaborated with healthcare teams to assess and improve patient care plans based on utilization guidelines.
Education
Bachelor of Science - Nursing
Nueva Ecija University of Science And Technology
Philippines04-2010
Skills
- Utilization Review
- Patient Assessment
- Health Regulations
- Collaboration Skills
- Medical Necessity
Timeline
Utilization Review Nurse (part Time)
Genex
12.2022 - 12.2023
Home Care Registered Nurse
Towne Nursing
07.2022 - Current
Workers Compensation Utilization Review Nurse
Shearwater Health
06.2021 - 06.2022
Utilization Review Nurse
EXL Service
02.2017 - 04.2021
Bachelor of Science - Nursing
Nueva Ecija University of Science And Technology