Summary
Overview
Work History
Education
Skills
Certification
Languages
Timeline
Generic

Elizabeth Gutierrez

Hialeah

Summary

Professional licensed practical nurse with strong background in utilization management. Skilled in assessing patient care needs, coordinating treatment plans, and ensuring compliance with healthcare regulations. Known for effective collaboration with multidisciplinary teams and driving results in dynamic healthcare environments. Reliable and adaptive, with focus on quality outcomes and patient advocacy.

Overview

15
15
years of professional experience
1
1
Certification

Work History

Utilization Management Nurse

CarePlus Health Plans
02.2019 - 06.2025
  • Conduct 40–50 utilization reviews daily for prior authorizations, adhering to Medicare guidelines.
  • Interpret and apply NCD, LCD, and MCG criteria to determine medical necessity.
  • Communicate with providers to clarify clinical documentation and rationale for care decisions.
  • Document interactions and decisions with accuracy and timeliness.
  • Collaborated with healthcare providers to optimize patient care plans and resource utilization.
  • Reviewed and authorized medical services to ensure compliance with clinical guidelines.

Utilization Review Nurse

Magellan Complete Care
04.2015 - 01.2019
  • Performed 15–25 precertification reviews daily using InterQual and Trucare systems.
  • Analyzed clinical documentation for coverage determinations based on medical necessity.
  • Ensured compliance with NCQA standards and health plan deadlines.
  • Provided timely communication to providers regarding decisions, including rationale and next steps.

Nurse Case Manager

Simply Healthcare Plans
10.2012 - 05.2014
  • Managed a caseload of 150+ members, providing health education and telephonic case management.
  • Developed and executed care plans focused on disease management (e.g., Asthma, COPD).
  • Completed daily Health Risk Assessments and followed up with members to ensure compliance.
  • Conducted home visits and coordinated DME, transportation, and provider appointments.

LPN

Community Center of Central Florida
08.2011 - 07.2012
  • Performed pediatric assessments, administered immunizations, and documented patient encounters.
  • Assisted physicians during procedures including circumcisions.
  • Educated parents on child wellness and development.

Asthma Case Manager / LPN

Pediatric Associates
01.2010 - 06.2011
  • Led an asthma case management program, reducing ER visits by 60% in one year.
  • Conducted parent education via video, print materials, and newsletters.
  • Maintained patient records and compliance logs to track progress and improve outcomes.

Education

Licensed Practical Nursing License -

Medvance Institute
01.2008

Skills

  • Utilization Review & Management
  • Case Management (Pediatric & Geriatric)
  • InterQual & MCG Guidelines
  • Discharge Planning
  • Electronic Medical Records (EMR)
  • Medicare, ICD-10
  • Medical Necessity Criteria (MNC)
  • Telephonic Patient Education
  • Bilingual: English & Spanish
  • EMR Systems
  • Microsoft Word
  • Trucare
  • InterQual & MCG
  • ICD-10

Certification

  • Licensed Practical Nurse (FL)
  • CPR Certified

Languages

Spanish
Native or Bilingual

Timeline

Utilization Management Nurse

CarePlus Health Plans
02.2019 - 06.2025

Utilization Review Nurse

Magellan Complete Care
04.2015 - 01.2019

Nurse Case Manager

Simply Healthcare Plans
10.2012 - 05.2014

LPN

Community Center of Central Florida
08.2011 - 07.2012

Asthma Case Manager / LPN

Pediatric Associates
01.2010 - 06.2011

Licensed Practical Nursing License -

Medvance Institute

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