Gina Rouzeau, RN, CCM
Boca Raton,FL
Summary
Dedicated Health Care Professional, Registered Nurse with over 20+ years experience in various nursing roles. Pivotal role in Case Management and Utilization review specializing in care coordination, medical necessity determination and regulatory compliance. Proven leader in optimizing length of stay, reducing denials improving patient throughput, and enhancing interdisciplinary collaboration. Strong background in InterQual / Milliman, denial prevention, and audit readiness. Currently assisting in managing a team of over 70 case managers, social workers, and ED Point of Entry staff ensuring compliance with best practices and standards.
Overview
7
7
years of professional experience
Work History
Manager, Case Management
Memorial Regional Hospital Hollywood
03.2022 - Current
- Supervise and support case managers, social workers and Point of Entry Staff
- Oversee daily operations ensuring compliance with healthcare regulation and best practices
- Oversee care coordination and discharge planning processes
- Collaborate with interdisciplinary teams to streamline workflows and improve patient flow and throughput.
- Oversee ED Point of Entry team to reduce ED boarding
- Ensure appropriate level of care determinations (inpatient, observation, outpatient)
- Track length of stay (LOS) and avoidable days
Pool Utilization Rev RN
Boca Raton Regional Hospital
06.2019 - Current
- Applied expertise in MCG Milliman guidelines and InterQual standards to enhance clinical decision-making processes.
- Conducted comprehensive medical necessity reviews to ensure adherence to payor criteria compliance.
- Ensure proper documentation to support medical necessity
- Oversee denial prevention and appeals processes
- Track length of stay and avoidable days
Education
Associate of Science - Registered Nurse
Helene Fuld College of Nursing
New York, NYLPN - Practical Nursing
BOCES
Nassau, NYSkills
- Certified in Case Management
- Proficient in InterQual / Milliman criteria application
- Proficient in concurrent review documentation
- Electronic Medical Record (EMR) proficiency (EPIC, Cerner )
- Payer portal navigation
Timeline
Manager, Case Management
Memorial Regional Hospital Hollywood
03.2022 - Current
Pool Utilization Rev RN
Boca Raton Regional Hospital
06.2019 - Current
Associate of Science - Registered Nurse
Helene Fuld College of Nursing
LPN - Practical Nursing
BOCES