Heidy Lopez Benitez
Kissimmee,FL
Summary
Utilization Review Nurse with clinical nursing experience and medical management software program expertise. Performs thorough review of requests for prior authorization of medical services, including diagnostic, outpatient care and services using defined criteria. In-depth knowledge of disease process, medical terminology and diagnostic data and working knowledge of managed care guidelines and regulations.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Registered Nurse
Health Trust Staffing-HCA
Kissimmee, FL
02.2025 - Current
- Conducted specified laboratory tests to help detect conditions and determine diagnosis.
- Monitored vital signs, intake and output levels, lab values and other assessments as needed.
- Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
- Coordinated with healthcare team to establish, enact and evaluate patient care plans.
- Coordinated discharge planning to ensure continuity of care post-hospitalization.
- Provided direct patient care, including administering medications, treatments, and education to patients and families.
- Responded quickly to life-threatening situations while maintaining composure under pressure.
Utilization Review Nurse
Acentra Health
McLean, Virginia
06.2024 - 01.2025
- Conducted reviews of inpatient utilization for compliance with admission criteria and concurrent review requirements.
- Maintained up-to-date knowledge of health plan benefits, policies, procedures, regulations, coding guidelines.
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
- Reviewed denial letters issued by insurance companies to ensure that they were appropriate and timely.
- Collaborated with staff members in group meetings to identify issues and find cost-effective solutions.
Utilization Review Nurse
Health Dialog
Boston, Massachusetts
12.2022 - 03.2024
- Conducted thorough reviews of patient care plans for medical necessity.
- Collaborated with healthcare providers to ensure compliance with utilization guidelines.
- Analyzed clinical data to identify trends in service utilization.
- Developed and maintained accurate documentation of review processes and outcomes.
- Participated in interdisciplinary meetings to discuss complex cases and treatment options.
- Evaluated clinical documentation for accuracy and completeness in order to make decisions about coverage determinations.
Registered Nurse, Emergency Department
Osceola Regional Medical Center
Kissimmee, FL
01.2021 - 10.2022
- Documented patient progress notes accurately and efficiently in the electronic medical record system.
- Utilized critical thinking skills to assess clinical situations quickly and accurately.
- Monitored and managed various treatment and care interventions.
- Assessed patient conditions and provided critical care in emergency situations.
- Administered medications and treatments as prescribed by physicians.
Licensed Practical Nurse
Orlando Health
Orlando, FL
08.2018 - 07.2019
- Administered medications and treatments according to established protocols.
- Assessed patient complaints accurately and provided appropriate interventions.
- Collected biological samples from patients and performed routine lab tests to support diagnosis.
- Participated in quality improvement initiatives to enhance patient care outcomes.
- Ensured that all clinical documentation is accurate and up-to-date in the electronic medical record system.
- Coordinated with doctors and registered nurses to develop care plans for patients.
Education
Associate of Science - Nursing
Herzing University
Winter Park08.2020
Diploma - Practical Nursing
Jersey College
Teterboro, NJ03-2016
Skills
- Utilization management
- Interdisciplinary collaboration
- Quality improvement
- Effective communication
- Interqual
- MCG
Certification
• Registered Nurse, FL RN9551086, exp. 07/2026
Timeline
Registered Nurse
Health Trust Staffing-HCA
02.2025 - Current
Utilization Review Nurse
Acentra Health
06.2024 - 01.2025
Utilization Review Nurse
Health Dialog
12.2022 - 03.2024
Registered Nurse, Emergency Department
Osceola Regional Medical Center
01.2021 - 10.2022
Licensed Practical Nurse
Orlando Health
08.2018 - 07.2019
Associate of Science - Nursing
Herzing University
Diploma - Practical Nursing
Jersey College