Iris Barrera
San Marcos,TX
Summary
Highly analytical and results-driven Registered Nurse with 13 years of progressive clinical and case management experience, specifically leveraging expertise in utilization management and complex case analysis. Proven ability to interpret and ensure compliance with healthcare requirements, guidelines, and protocols, including direct experience with InterQual criteria for medical necessity reviews. Adept at critical thinking, research, and collaborating with interdisciplinary teams, seeking to apply extensive clinical knowledge and analytical skills to a Managed Care Nurse Analyst role at Texas Health and Human Services Commission.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Registered Nurse/RN Case Manager
Baylor Scott & White Hospitals
Central Texas Market, TX
10.2024 - Current
- Conducted comprehensive concurrent and retrospective reviews using InterQual criteria to determine medical necessity for patient admissions and ongoing care, significantly optimizing resource allocation and reimbursement strategies.
- Performed detailed clinical documentation reviews and patient assessments to facilitate effective case management, discharge planning, and post-acute care coordination for complex chronic conditions, ensuring adherence to care guidelines.
- Applied advanced analytical skills to identify and proactively address care gaps within managed care models, contributing to enhanced patient outcomes and continuity of care.
- Collaborated strategically with interdisciplinary teams, including physicians, and allied health professionals, to ensure seamless transitions and coordinated delivery of medically necessary services.
Registered Nurse/RN Case Manager
Advantis Medical Staffing
Various, Nationwide
06.2021 - 11.2023
- Provided direct, high-acuity nursing care to a diverse patient population, including complex cardiology cases (e.g., heart transplant, pacing wires, cardiac drips), and patients with end-stage renal disease and diabetes on insulin drips, demonstrating broad clinical knowledge and critical assessment skills.
- Managed post-operative patient care, including monitoring for complications and implementing recovery protocols, ensuring adherence to physician orders and hospital policies.
- Facilitated seamless transitions of care for patients discharging to rehabilitation facilities and long-term care, requiring meticulous planning and coordination with interdisciplinary teams.
- Coordinated durable medical equipment (DME) needs for patients, demonstrating an understanding of post-acute care requirements, and resource management.
- Applied advanced critical thinking to manage rapidly changing patient conditions and complex medication regimens, ensuring patient safety and optimal outcomes.
Nurse Case Manager and Consultant
Heartland National Tuberculosis Center
San Antonio, TX
09.2018 - 06.2021
- Served as a subject matter expert in TB case management and guidelines, providing consultation and support, while ensuring strict adherence to national and international regulatory frameworks and contractual obligations (CDC Contract).
- Conducted comprehensive gap analyses of clinical protocols and guidelines, identifying opportunities for process improvements that significantly enhanced efficiency and reduced consultation times.
- Actively participated in multi-jurisdictional programs, performing in-depth reviews and analyses of proposed clinical guidelines (pre-publication) and order sets to ensure clarity, compliance, and effective implementation strategies.
- Collaborated with interdisciplinary teams, providing training and guidance on complex clinical guidelines, and their practical implementation.
Tuberculosis Nurse Case Manager/Division Chief of Communicable Diseases
Hays County Health Department
San Marcos, TX
09.2015 - 09.2018
- Developed and managed individualized case management plans, leveraging telephonic communication for patient monitoring and adherence to prescribed care.
- Monitored and analyzed clinical care plans, including medical history, medication adherence, and laboratory data, to ensure optimal patient outcomes, and compliance with treatment standards.
- Contributed to the development of county healthcare standards through comprehensive reviews of state and federal program requirements, regulations, and grant directives.
- Monitored and responded to state-mandated notifiable condition notifications, ensuring timely and compliant reporting within established timelines, and educating area providers on reporting requirements and public health guidelines.
- Delivered comprehensive case management through home, telephone, and clinic visits.
Education
Associate of Science - Nursing
Austin Community College
Austin, TX05-2012
Bachelor of Science - Nursing
Western Governors University
Salt Lake City, UTSkills
- Managed care and utilization management
- Policy and regulatory compliance
- Complex case assessment and analysis
- EHR proficiency and technical skills: MS Office Suite, TEAMS, InterQual, Excel
- Critical thinking and problem-solving
- Interdisciplinary collaboration and communication
- Case management and care coordination
- Remote work experience, self-directed
- Chronic disease management
Certification
- Texas Enhanced Nurse Licensure Compact eNLC #819089
- Advanced Life Support (ALS)
- Basic Life Support (BLS)
- NIH Stroke Scale
Accomplishments
- International Daisy Award for Nursing Excellence Recipient
- Preceptor of the Year Seton Medical Center Austin
References
References available upon request.
Timeline
Registered Nurse/RN Case Manager
Baylor Scott & White Hospitals
10.2024 - Current
Registered Nurse/RN Case Manager
Advantis Medical Staffing
06.2021 - 11.2023
Nurse Case Manager and Consultant
Heartland National Tuberculosis Center
09.2018 - 06.2021
Tuberculosis Nurse Case Manager/Division Chief of Communicable Diseases
Hays County Health Department
09.2015 - 09.2018
Associate of Science - Nursing
Austin Community College
Bachelor of Science - Nursing
Western Governors University
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