Gesta Margarita Ponce, RN, BSN
Arlington Heights,IL
Summary
- Successful Registered Nurse professional and Bachelor of Science degree holder with over 2 years of post acute care experience, 7 years of Utilization Management experience and over 1 year of Endoscopy experience.
- Organized nurse manager dedicated to maintaining high-performance and quality-driven healthcare unit
- 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 nurse
- Strong background in Utilization Management with remote work experience
Overview
11
11
years of professional experience
Work History
Nurse
Alexian Brothers Medical Center
Elk Grove, IL
04.2023 - Current
- Provide direct nursing care in accordance with established policies, procedures and protocols of the healthcare organization.
- Implement and monitor patient care plans.
- Monitor, record, and communicate patient condition as appropriate.
- Serve as a primary coordinator of all disciplines for well-coordinated patient care.
- Note and carry out physician and nursing orders.
- Assess and coordinate patient's discharge planning needs with members of the healthcare team.
Nurse Unit Manager
ProMedica Skilled Nursing and Rehabilitation
Arlington Heights, IL
08.2022 - 12.2022
- Oversee the care management of a population of patients within an assigned area, unit or clinical function
- Conduct nursing process, assessment, planning, implementation, and evaluation under the scope of the State's Nurse Practice Act of Registered Nurse licensure.
- Coordinates resource utilization, timely and appropriate care interventions, and interdisciplinary communication to enhance patient and family satisfaction, adherence to center's clinical systems and regulatory compliance
Clinical Care Reviewer
AmeriHealth Caritas
Palm Beach Gardens, FL
01.2020 - 11.2021
- Conducts clinical review of cases in accordance with state guidelines or company policy. Requests such as physical, occupational, and speech therapy, durable medical equipments, home health, imaging tests, inpatient and outpatient procedures, and transplants
- Collects and enters confidential information ensuring the highest level of confidentiality in all areas
- Refers cases to physician reviewer per guidelines
- Maintains written documentation according to client's documentation policy
- Provides ongoing telephonic education to provider's and office staff related to client's clinical review process
- Refers members to case management or another department when necessary
- Assists in orientation and training new clinical reviewers in department procedures, protocols, and administrative tasks when requested
Charge Nurse
Medicana Nursing and Rehab Center
Lake Worth, FL
03.2019 - 03.2021
- Assesses patients by physical examination including pertinent diagnostic testing to determine health status
- Administers medications and treatments (oxygen, tracheostomy care, PEG tube care, wound care, ostomy care, etc.)
- Participates in the care planning process and oversees implementation of the plan
- Supervises LPNs and nursing assistants
- Communicates with MD regarding changes in conditions, diagnostic test results, etc.
- Documents assessments and care in compliance with standards of care and company policy
- Educates patients and their families on health-related issues
- Assists in orientation and training of new charge nurses
Clinical Nurse Reviewer
WNS Global Services-Healthhelp
Muntinlupa , Philippines
06.2017 - 01.2019
- Conducts clinical review of diagnostic imaging tests for Healhhelp Humana clients in accordance with state guidelines or company policy.
- Collects and enters confidential information ensuring the highest level of confidentiality in all areas
- Refers cases to physician reviewer per guidelines
- Maintains written documentation according to client's documentation policy
- Provides ongoing telephonic education to provider's and office staff related to client's clinical review process
- Refers members to case management or another department when necessary
- Assists in orientation and training new clinical reviewers in department procedures, protocols, and administrative tasks when requested
Utilization Management Nurse
EXL Service-Aetna
Pasay, Philippines
01.2014 - 05.2017
- Conducts clinical review of specialty medications for Aetna Medicare clients in accordance with state guidelines or company policy
- Collects and enters confidential information ensuring the highest level of confidentiality in all areas
- Refers cases to physician reviewer per guidelines
- Maintains written documentation according to client's documentation policy
- Provides ongoing telephonic education to provider's and office staff related to client's clinical review process
- Refers members to case management or another department when necessary
- Assists in orientation and training new clinical reviewers in department procedures, protocols, and administrative tasks when requested
Education
Bachelor of Science - Nursing
Lyceum of The Philippines University Batangas
Capitol Site, Batangas City Philippines03.2012
Skills
- Supervision & Leadership
- Organizational Skills
- Training
- Post acute care
- Microsoft office
- Microsoft outlook
- Jiva
- InterQual
- CMS
- Cerner
- Medicaid and Medicare experience
- Strong interpersonal and communication skills
- Independent worker in a fast-paced evolving environment using available resources provided by the company
- Fast learner
- Multi-task
- Critical thinking
- Team player
- Highly motivated
Professional Licensure and Certifications
- Active Registered Nurse in the state of Illinois with license number 041.535628 valid until 5/31/2026
Timeline
Nurse
Alexian Brothers Medical Center
04.2023 - Current
Nurse Unit Manager
ProMedica Skilled Nursing and Rehabilitation
08.2022 - 12.2022
Clinical Care Reviewer
AmeriHealth Caritas
01.2020 - 11.2021
Charge Nurse
Medicana Nursing and Rehab Center
03.2019 - 03.2021
Clinical Nurse Reviewer
WNS Global Services-Healthhelp
06.2017 - 01.2019
Utilization Management Nurse
EXL Service-Aetna
01.2014 - 05.2017
Bachelor of Science - Nursing
Lyceum of The Philippines University Batangas
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