Elsa Rojas
McAllen,Texas
Summary
As a registered nurse, I have gained extensive experience in various aspects of hospital care, both at the bedside and in an office setting. The primary objective is to provide excellent customer service to patients and ensure clients are satisfied with the care received. Daily tasks include the ability to organize and manage different and complex cases as well as perform daily clinical reviews to ensure patients meet medical necessity. The daily goal is to strive and make a positive difference in the lives of those served.
Overview
13
13
years of professional experience
Work History
RN Lead Case Manager /Clinical Review Nurse
Mission Regional Medical Center
10.2018 - Current
- RN Case Manager Supervisor, Take the role of assisting our team of case managers with more complex cases in the discharge planning process
- Perform assigned clinical reviews, interpret CMS guidelines accurately, and guide team members
- Speak to physicians and coordinate with ancillary teams on discharge planning
- Confidently initiate telephone communication with insurance case managers to discuss pending admission to skilled nursing facilities, medications, and outpatient IV antibiotic arrangements authorizations
- Assist and train newly employed case managers in implementing the appropriate discharge planning processes and other assigned tasks within case management
- As part of my responsibilities, I communicate openly with the Director of Case Management
- I prepare comprehensive reports daily to evaluate the utilization of resources
- These reports cover various aspects such as geometric length of stay, observation, and inpatient status
- The primary goal of these reports is to assess the appropriateness of admission and ensure that all patients receive the necessary care in a timely and efficient manner and to maintain the appropriate length of stay.
RN Case Manager/Clinical/Utilization Review Nurse
Doctors Hospital at Renaissance
03.2012 - 10.2018
- As Case Manager, core component of duties involved carrying out utilization and concurrent reviews for multiple payers, including Medicare, Medicaid, and privately managed insurance provider
- Used InterQual and Milliman guidelines to ensure adherence to industry best practices. Perform clinical review of claim data and medical records to determine medical necessity, coverage, and appropriateness of care based on accepted medical standards and local and national policies
- Daily responsibilities also extended to discharge planning for various units, encompassing Medical, Telemetry, Cath Lab, Pediatric PICU/Hematology, and Oncology floors.
- Coordinating with physicians and other healthcare professionals to ensure efficient and effective transition of patients from hospital care to post-discharge arrangements.
Registered Nurse
Doctors Hospital at Renaissance
03.2012 - 09.2013
- As a floor Registered Nurse in the Medical Unit, I took charge of caring for patients with acute illnesses such as a patient with CHF, acute renal failure, and complex wound care
- I was responsible for adhering to nursing processes and care plans, documenting patients' information electronically in their charts, and notifying physicians of any changes in their condition or abnormal lab results
- I ensured that my patients received the best possible care and attention, and I was confident in my ability to handle any challenges that came my way.
Registered Nurse
Knapp Medical Center
12.2010 - 03.2012
- As a registered nurse, I provided healthcare services to patients admitted to the medical unit
- The unit catered to patients suffering from diverse illnesses, including End-Stage Renal Disease (ESRD) requiring Dialysis, Cancer/Chemotherapy, Substance abuse, and complex wound care
- My primary responsibilities included administering medication, monitoring vital signs, educating patients on their condition, and assisting doctors during bedside procedures
- My experience in the medical unit allowed me to develop strong communication and critical thinking skills, which enabled me to provide high-quality care to my patients.
Education
Bachelor of Science - Registered Nurse
Grand Canyon University
Phoenix03.2023
Associate degree in Registered Nursing -
South Texas College
McAllen, Texas05.2010
High School Diploma -
Donna High School
Donna, Texas05.1993
Skills
- Collaboratively communicate with interdisciplinary team members
- Discharge planning
- Concurrent Reviews of patient charts
- Proficient in both verbal and written English and Spanish
- Excellent customer service
- Knowledge of Microsoft Office, Word, Excel, and PowerPoint
- Ability to assess medical necessity, appropriateness, and level of care with confidence while handling complex cases that require prior authorization or review
Additional Information
Currently pursuing a bachelor’s degree in nursing at Grand Canyon University, expected graduation date is March 2024.
References
References are provided upon request.
Timeline
RN Lead Case Manager /Clinical Review Nurse
Mission Regional Medical Center
10.2018 - Current
RN Case Manager/Clinical/Utilization Review Nurse
Doctors Hospital at Renaissance
03.2012 - 10.2018
Registered Nurse
Doctors Hospital at Renaissance
03.2012 - 09.2013
Registered Nurse
Knapp Medical Center
12.2010 - 03.2012
Bachelor of Science - Registered Nurse
Grand Canyon University
Associate degree in Registered Nursing -
South Texas College
High School Diploma -
Donna High School
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