Diana Merz-Pena
San Antonio,TX
Summary
Skilled Utilization Review Nurse offering talents in continuous assessments and clinical records oversight. Pleasant individual with over 13 years in the nursing field. Ready to join new company that appreciates attention to detail and exemplary clinical review skills. Experienced nursing professional bringing demonstrated clinical expertise, leadership skills and technical knowledge. Proficient in updating charts, monitoring medications and working with multidisciplinary teams to optimize patient care. Quality-driven and efficient with strong interpersonal abilities.
Overview
12
12
years of professional experience
Work History
Utilization Review Nurse
WellMed/Optum
San Antonio, Texas
02.2021 - Current
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
- Monitored pre-authorization requests to ensure that all necessary information was received prior to approval or denial of services.
Utilization Review Nurse
Nexus Medical Consulting
Schertz, TX
10.2014 - 02.2021
- Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
- Reviewed patient admissions to determine medical necessity as directed by state guideline criteria.
- Determined medical necessity and cost-effectiveness of services through utilization review processes.
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
LVN
Oak Park Nursing Home
San Antonio, TX
08.2014 - 10.2014
- Administered prescribed medications and started intravenous fluids to address patient symptoms and underlying etiologies.
- Answered patient calls, identified issues and determined how best to provide assistance within parameters established by facility and supervisor.
- Managed patients' hygiene with comprehensive care for toileting, bathing and grooming needs.
- Observed strict confidentiality and safeguarded all patient-related information.
- Assisted with patients' nutritional needs by setting up self-feeding assistance or directly feeding individuals with severely limited mobility.
- Inserted, cared for and removed patients' catheters and monitored urine output.
- Collected biological samples for routine laboratory testing to assist diagnostic processes.
- Evaluated patient care procedural changes for effectiveness and made necessary adjustments.
- Sterilized equipment and supplies using germicides and autoclaves to protect patients and staff from infection.
- Charted changes in patient conditions and discussed concerns with supervising healthcare provider.
- Cared for patients' acute and chronic wounds by changing dressings and applying medicated compounds.
Home Health LVN
Epic Health Services
San Antonio, TX
03.2013 - 08.2014
- Administered prescribed medications and started intravenous fluids to address patient symptoms and underlying etiologies.
- Cared for patients' acute and chronic wounds by changing dressings and applying medicated compounds.
- Evaluated patient care procedural changes for effectiveness and made necessary adjustments.
- Assisted with patients' nutritional needs by setting up self-feeding assistance or directly feeding individuals with severely limited mobility.
- Managed patients' hygiene with comprehensive care for toileting, bathing and grooming needs.
- Addressed patient care needs, collected vitals, dressed wounds and managed catheters.
- Directed implementation of improved patient care and documentation methods and procedures to achieve quality objectives.
Education
Licensed Vocational Nurse - Vocational Nursing
Career Point College
San Antonio, TX09.2012
Skills
- Utilization review
- Patient transfers and transitions
- Skilled in Microsoft Word, Excel, Office
- Continuous assessments
- Acute and rehabilitative care
- Geriatric treatment knowledge
- Diagnostic tools experience
- Medication and IV administration
- Broad medical terminology knowledge
Timeline
Utilization Review Nurse
WellMed/Optum
02.2021 - Current
Utilization Review Nurse
Nexus Medical Consulting
10.2014 - 02.2021
LVN
Oak Park Nursing Home
08.2014 - 10.2014
Home Health LVN
Epic Health Services
03.2013 - 08.2014
Licensed Vocational Nurse - Vocational Nursing
Career Point College