Jaisan James Custorio
Watertown,Wisconsin
Summary
Proven Mental Health Nurse with a track record of delivering patient-centered care at Watertown Regional Medical Center. Excelled in clinical documentation and de-escalation, enhancing patient outcomes and safety. Skilled in utilizing review and patient care plans, achieving a significant improvement in treatment efficacy. Demonstrates exceptional motivational interviewing and behavioral management, contributing to a positive and impactful patient experience.
Overview
15
15
years of professional experience
Work History
Mental Health Nurse
Watertown Regional Medical Center
04.2023 - Current
- Assessed patients' physical and mental status by analyzing complaints and symptoms.
- Educated patients about medical conditions and mental health, medications, treatments and preventive measures.
- Performed frequent ongoing assessments of patients' status to address changes.
- Sustained quality standards by performing routine medication audits and upholding internal and industry best practices.
- Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
- Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Conveyed treatment options, diagnosis information and home care techniques to patients to continue care consistency.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Determined patient risk by utilizing subjective and objective data obtained through patient interaction.
Utilization Review Registered Nurse
Calibrated Health Network
04.2022 - 11.2022
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Process 30 to 40 authorization cases per day.
- Devise or identify solutions for irregular requests and issues.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Evaluated patient histories, complaints, and current symptoms.
HEDIS Review Nurse (Project Based)
Cognizant Technology Solutions Philippines, Inc
01.2022 - 04.2022
- Researched and validated clinical data.
- Applied knowledge, data, information and workflow to develop evidence-based models for health information technology solutions.
- Process 50 cases per day.
Mental Health Registered Nurse
National Center for Mental Health
02.2020 - 05.2021
- Educated patients and family members about medical conditions and mental health, medications, treatments and preventive measures.
- Assessed patients' physical and mental status by analyzing complaints and symptoms.
- Implemented group therapies and programs to help patients improve or regain coping abilities.
- Determined patient risk by utilizing subjective and objective data obtained through patient interaction.
- Performed frequent ongoing assessments of patients' status to address changes.
- Evaluated, ordered and interpreted psychological evaluations and basic lab tests to assess and identify patients' conditions.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Recorded details regarding therapies to keep patient charts updated.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
- Performed frequent checks on life support equipment and made necessary adjustments to preserve optimal patient conditions.
- Evaluated patient histories, complaints, and current symptoms.
- Performed triage on incoming patients and determined severity of mental illness.
- Observed and documented patient factors such as diets, physical activity levels, and behaviors to understand conditions and effectively modify treatment plans.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities.
- Monitored patient reactions after administering medications and IV therapies.
Team Lead (BCBS)
Conduent Inc.
06.2016 - 08.2017
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Provided primary customer support to Medical Providers regarding member's medical insurance benefit and claims.
- Consulted with outside parties to resolve discrepancies and create expert solutions.
- Process approximately 20 to 30 escalation calls and emails per day,
- Answered constant flow of customer calls with minimal wait times.
- Provide medical provider information regarding patient's medical insurance eligibility.
- Analyzed data to identify root causes of problems and recommend corrective actions.
- Coached team members in techniques necessary to complete job tasks.
- Developed effective improvement plans in alignment with goals and specifications.
- Evaluated staff performance and provided coaching to address inefficiencies.
Health Care Advocate (Aetna)
Hinduja Global Solutions, HGS
05.2012 - 01.2014
- Responded to customer requests for products, services, and company information.
- Enhanced productivity levels by anticipating needs and delivering outstanding support.
- Delivered prompt service to prioritize customer needs.
- Educated members about eligibility, claims, and benefit information.
- Maintained up-to-date knowledge of product and service changes.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Met customer call guidelines for service levels, handle time and productivity.
Staff Nurse (Project Based)
Northern Samar Provincial Hospital
05.2009 - 06.2011
- Observed and documented patient factors such as diets, physical activity levels, and behaviors to understand conditions and effectively modify treatment plans.
- Explained course of care and medication side effects to patients and caregivers in easy-to-understand terms.
- Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
- Performed frequent checks on life support equipment and made necessary adjustments to preserve optimal patient conditions.
- Participated in evidence-based practice project implementation, nursing competency development and nursing simulation activities.
- Evaluated patient histories, complaints, and current symptoms.
Education
Bachelor of Science - Nursing
Colegio De San Lorenzo Ruiz De Manila
Catarman, Northern Samar04.2008
Bachelor of Science - Nursing
Colegio De San Lorenzo Ruiz De Manila
Catarman, Northern Samar04.2008
Skills
- Clinical Documentation
- De-Escalation Techniques
- Referral Coordination
- Patient Health Education
- HIPAA
- Medication Administration
- Behavioral Management
- Records Maintenance
- Healthcare regulations
- Utilization review
- Clinical assessment
- Records analysis
- HIPAA Compliance
- Insurance Verification
- Utilization Management
- Patient Care Plans
Timeline
Mental Health Nurse
Watertown Regional Medical Center
04.2023 - Current
Utilization Review Registered Nurse
Calibrated Health Network
04.2022 - 11.2022
HEDIS Review Nurse (Project Based)
Cognizant Technology Solutions Philippines, Inc
01.2022 - 04.2022
Mental Health Registered Nurse
National Center for Mental Health
02.2020 - 05.2021
Team Lead (BCBS)
Conduent Inc.
06.2016 - 08.2017
Health Care Advocate (Aetna)
Hinduja Global Solutions, HGS
05.2012 - 01.2014
Staff Nurse (Project Based)
Northern Samar Provincial Hospital
05.2009 - 06.2011
Bachelor of Science - Nursing
Colegio De San Lorenzo Ruiz De Manila
Bachelor of Science - Nursing
Colegio De San Lorenzo Ruiz De Manila
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