Guadalupe Cabrera
Mount Pleasant,TX
Summary
Registered Nurse with 7 years of outpatient case management and 1.5 years of combined inpatient case management and utilization management experience. Focused on identifying medically necessary care and producing accurate data for healthcare quality improvement. Skilled in resolving complex client issues and collaborating with multidisciplinary teams to achieve effective outcomes.
Overview
10
10
years of professional experience
Work History
Case Management/Utilization Management
Titus Regional Medical Center
Mount Pleasant, USA
05.2023 - Current
- Perform utilization reviews utilizing InterQual for ER, ICU, Med/Surg, NICU, Pediatrics, and L&D
- Collaborate with physicians regarding IP and OBS status, schedule peer to peers in a timely manner and obtain relevant clinical information for medical director prior to peer to peer, forward denials to the billing department, update EMR to reflect correct authorizations status, maintain HIPPA compliance, collaborate with insurance agents and case managers
- Initiate authorizations for IP stay via phone or through portals
- Perform discharge planning, initiate skilled nursing facility authorizations, collaborate with SNF, HH, and PCP
- Collaborate with KEPRO for inpatient appeals, obtain IMM and MOON, and collaborate with physicians, patients and insurance agents
RN Case Manager-PRN
Chambers Hospice
09.2022 - 05.2023
- Promoted adherence to treatment plans by conducting PRN visits and providing ongoing support to patients.
- Provided support to patients coping with chronic illness or end-of-life decisions, fostering resilience during difficult times.
Wound Care Case Manager
Titus Regional Medical Center
Mount Pleasant, USA
08.2016 - 05.2023
- Case manage for up to 20 patients; ensure goal healing rates are met and investigate any delays in wound healing and present findings to disciplinary team
- Perform hyperbaric oxygen treatments quarterly to ensure training and compliance, capture appropriate CPT codes for procedures to assist with billing
RN Case Manager
Heart To Heart Hospice
Mount Pleasant, TX
02.2016 - 08.2016
- Provided emotional support to patients coping with chronic illness or end-of-life decisions, fostering resilience during difficult times.
- Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
- Collaborated closely with physicians to develop individualized treatment plans, supporting optimal patient outcomes.
Registered Nurse
Titus Regional Medical Center
Mount Pleasant, USA
05.2015 - 05.2016
- Med/Surg
Education
Master’s Degree - Nursing
University of Texas At Tyler
Tyler, TX08-2026
Bachelor’s Degree - Nursing
University of Texas At Tyler
Tyler, TX08.2023
Skills
- Investigative
- Critical thinker
- Team Player
- Detail-oriented
- Medical Chart Review
- Prior-Authorization
- Utilization Management
- InterQual
- Epic Systems
- Discharge Planning
- Patient advocate
- Empathetic
- Bilingual-Spanish
License
Registered Nursing - Multistate, 879184, Exp: 11/30/25
Languages
Spanish
Native or Bilingual
Timeline
Case Management/Utilization Management
Titus Regional Medical Center
05.2023 - Current
RN Case Manager-PRN
Chambers Hospice
09.2022 - 05.2023
Wound Care Case Manager
Titus Regional Medical Center
08.2016 - 05.2023
RN Case Manager
Heart To Heart Hospice
02.2016 - 08.2016
Registered Nurse
Titus Regional Medical Center
05.2015 - 05.2016
Master’s Degree - Nursing
University of Texas At Tyler
Bachelor’s Degree - Nursing
University of Texas At Tyler