Job Search Status
Open to workDesired start date: 2 weeks notice
Open To Work
Ilda Reina Brown
Registered Nurse
Hunt,TX
Work Preference
Summary
Experienced healthcare professional with strong background in utilization review and care coordination. Proven ability to assess medical necessity, optimize resource use, and ensure compliance with healthcare regulations. Focused on team collaboration and achieving results, adapting to changing needs efficiently. Highly skilled in clinical guideline adherence, patient advocacy, and effective communication.
Overview
11
11
years of professional experience
Work History
Utilization Review Coordinator
Peterson Health
Kerrville, TX
02.2021 - Current
- Led utilization review processes to ensure compliance with healthcare regulations.
- Collaborated with multidisciplinary teams to optimize patient outcomes through effective care coordination.
- Trained and mentored junior staff on utilization review best practices and documentation standards.
- Facilitated communication between providers, patients, and insurance companies to streamline authorization processes.
- Presented findings and recommendations to senior leadership for enhancing operational efficiency in utilization review activities.
- Conducted regular audits of clinical documentation for accuracy and adherence to policies which resulted in 10% increase in accuracy.
Case Manager
Peterson Health
Kerrville, TX
08.2019 - 02.2021
- Coordinated patient care plans to optimize health outcomes and resource utilization.
- Conducted comprehensive assessments to identify patient needs and develop tailored interventions.
- Collaborated with multidisciplinary teams to ensure continuity of care and effective communication.
- Monitored patient progress, adjusting care strategies based on evolving health status.
- Educated patients and families on disease management and available community resources which improved patient satisfaction scores for the department.
Critical Care Registered Nurse
Peterson Health
Kerrville, TX
01.2016 - 04.2019
- Administered critical care interventions to stabilize patients in high-acuity environments.
- Enhanced interdisciplinary collaboration for optimal patient care by effectively communicating with physicians, pharmacists, and other healthcare professionals.
- Utilized advanced assessment skills to continually evaluate patients'' responses to treatments and adjust care plans as needed for optimal outcomes.
- Demonstrated strong clinical judgment when prioritizing patient needs during high-stress situations requiring rapid decision-making skills.
- Contributed to a positive work environment by mentoring new nurses and serving as a resource for colleagues seeking guidance on complex clinical situations.
Med/Medical Surgical Staff Registered Nurse
Peterson Health
Kerrville, TX
01.2015 - 01.2016
- Administered medications and treatments as prescribed, ensuring patient safety and compliance with protocols.
- Monitored vital signs and assessed patient conditions to identify changes in health status.
- Coordinated with multidisciplinary teams to create and implement individualized care plans for patients.
- Streamlined documentation processes using electronic health records to improve accuracy and efficiency.
- Collaborated with interdisciplinary healthcare teams to provide comprehensive patient care during hospitalization and discharge planning.
- Managed caseload of six patients simultaneously by providing bedside care, treatments, IV therapy, and wound care.
Education
Associate of Science - Nursing
San Antonio College
San Antonio, TX12-2014
Skills
- HIPAA compliance
- Quality improvement
- Healthcare regulations
- Interdisciplinary collaboration
- Medical necessity assessment
- Case review expertise
- Discharge planning coordination
- Clinical assessment
- Utilization management
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Accomplishments
- Collaborated with Care Coordination team in the development of streamlining the process for obtaining Prior Authorizations for Acute Care patients.
Timeline
Utilization Review Coordinator
Peterson Health
02.2021 - Current
Case Manager
Peterson Health
08.2019 - 02.2021
Critical Care Registered Nurse
Peterson Health
01.2016 - 04.2019
Med/Medical Surgical Staff Registered Nurse
Peterson Health
01.2015 - 01.2016
Associate of Science - Nursing
San Antonio College