Divina Meng

• Maintained strict adherence to HIPAA regulations, safeguarding sensitive patient information throughout all aspects of the utilization review process.
• Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
• Maintained up-to-date knowledge of payer-specific guidelines to ensure accurate authorizations for medically necessary services.
• Increased efficiency in case management documentation by maintaining organized records and utilizing electronic medical record systems.
• Coordinated seamless transitions of care across multiple settings including acute care hospitals, rehabilitation facilities, and home care services.
• Applied critical thinking skills to assess complex medical cases and determine appropriate levels of care in accordance with industry benchmarks.
• Ensured compliance with regulatory guidelines by staying current on industry standards and participating in ongoing education opportunities.
• Contributed to team success by consistently meeting productivity goals while maintaining high-quality standards in job performance.
• Collaboration with Medical Director, discussing complex case for appropriateness at level of care and medical necessity.
• Good rapport with Hospital Utilization review nurses and case management nurses
• Access electronic medical records
• Team work , prioritizing deadlines TATS
• Assessed patience discharge planning, for example if the member needs LTAC,SNF,ARU

• Maintained strong working relationships with physicians and ancillary staff, fostering a collaborative approach to patient care delivery.
• Responded to patient emergencies to provide prompt and correct intervention .
• Educated patients and families to increase understanding of condition and best ways to manage.
• Collaborated with interdisciplinary teams for optimal patient outcomes and efficient care coordination.
• Mentored new nursing staff, fostering professional growth and team building within the unit.
• in 2020 , volunteered to be part of the COVID team, and was part of teaching the hospital regarding COVID
• Administered medications and treatments to manage patient's condition.
• Ensured accurate documentation of all patient records, contributing to improved quality assurance measures.
• Monitored patients, evaluated results, and recommended further courses of treatment to quickly improve patient outcomes.

As a new grad RN, i worked in Oncology department

Chemo certified

• Administered medications and treatments to manage patient's condition.
• Utilized evidence-based practice to assess and provide care for patients.
• Developed strong rapport with patients and families, promoting open communication channels for effective collaboration in treatment plans.
• Maintained patient confidentiality by protecting unauthorized access to personal information.