James Patrick Sibal
Medpoint Management
OXNARD,CA
1
Language
1
Certification
16
years of professional experience
Results-oriented Registered Nurse with expertise in enhancing clinical documentation and processes. Conducts thorough chart reviews and audits to ensure compliance with quality measures and documentation standards. Focused on leveraging clinical knowledge and leadership to transition into Quality Control or Utilization Review roles, driving improved patient outcomes and fostering continuous improvement in healthcare delivery.
Work History
Inpatient Nurse Case Manager
2 Months- Led inpatient care coordination, aligning treatment plans with interdisciplinary teams and discharge requirements.
- Collaborated with physicians and case managers to support timely admissions, transfers, and discharge planning.
- Documented assessments, interventions, and patient responses in electronic medical records with precision.
- Reviewed clinical charts for accuracy, completeness, and compliance with utilization management standards.
- Peer to Peer
- Directed utilization management workflows for medical necessity review and prior authorization decisions.
- Reviewed complex cases against InterQual and MCG criteria for appropriate level-of-care determinations.
Utilization Manager- Managed Care
4 Years 4 Months- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Participated in daily patient care rounds to discuss treatment plans with the healthcare team.
- Established performance targets for employees to enhance motivation and align with company objectives.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Performed admission reviews based on medical necessity based upon evidence- based criteria specification.
- Managed approximately 15 incoming calls per day, 20 Reviews per day, 5-10 discharges, 15 concurrent reviews
- Collaborated with leadership to devise initiatives for improving nursing satisfaction, retention and morale.
- Participated in evidence-based practice project implementation, nursing competency development and nursing simulation activities.
- Partnered with leadership to implement initiatives aimed at enhancing nursing satisfaction, retention, and morale.
- Set aggressive targets for employees to drive company success and strengthen motivation.
- Presented findings from routine restraint audits to quality departments and collaborated with team to develop corrective action plans for deficiencies.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- ppraPrior Auth for HLOC, ARU REQUEST, LTAC REQUEST Inpatient Review
Utilization Manager (Contract)- Military Treatment Facility
1 Year- Compiled daily reports summarizing key data and findings. and Conducted thorough reviews of patient charts for accuracy and compliance.
- Performed utilization reviews to assess medical necessity and appropriateness of services.
- Assist with Assisted in the Operation Fight Back initiative to enhance community engagement.
- Defined clear targets and objectives and communicated to other team members.
- Established team priorities, maintained schedules, and monitored performance to align with project goals.
- Defined targets and objectives, communicated effectively to ensure team alignment and understanding.
- Assist with Operation Fight Back
- Leveraged industry expertise and customer service skills to resolve customer concerns, fostering loyalty and satisfaction.
Registered Nurse
1 Year 8 Months- Advised patients and caregivers on wound management, discharge plans, safe medication use, and disease management to promote recovery and safety.
- Collaborated with healthcare team to plan and implement treatment strategies, enhancing patient outcomes.
- Evaluated patient histories, complaints, and current symptoms.
- Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use, and disease management.
- Educated family members and caregivers on patient care instructions to ensure continuity of care and support.
- Educated family members and caregivers on patient care instructions.
- Recorded details regarding therapies to keep patient charts updated.
RN Case Management (Contract) Calibrated Healthcare Management
2 Months- Managed case files for patient support and care coordination.
- Utilization Review for Third Party
- Secured authorizations from multiple insurance carriers, facilitating access to appropriate care levels.
- Conducted admission reviews for medical necessity based on [Type] specifications, ensuring compliance with standards.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Assessed medical guidelines and benefit coverage, confirming service appropriateness for patient needs.
Travel Medical/Surgical/Telemetry RN (Contract)- Acute
3 Months- Interviewed patients to gather medical information, weight, height, and vital signs, ensuring comprehensive understanding of health status.
- Monitored and documented patients' temperature, pulse, and blood pressure to support timely clinical decisions.
- Managed detailed patient records, including histories, vitals, and assessments, facilitating effective care coordination.
- Interviewed patients to obtain medical information, weight and height measurements and vital signs.
- Took and recorded patients' temperature, pulse and blood pressure.
Clinical Nurse (Contract) – Primary Care
1 Year 5 Months- 40% Direct patient care
- 60% Case Management
- Caseload 30/day or 100- 168 case/ week
- Collaborated with registered nurses to enhance overall patient well-being.
- Enhanced patient care delivery by reviewing and implementing clinical improvements.
- Performed vitals/glucose testing and assisted in administering injections and urinalysis.
- Provided patient education
- Created and executed nursing care plans tailored to individual patient needs.
- Managed patient cases to ensure effective coordination of care.
- Reviewed patient charts to ensure accuracy and completeness of records.
- Implemented risk management strategies to enhance patient safety and care quality.
Medical Surgical Nurse (Contract)- LTAC
1 Month- Interviewed patients to gather medical information, weight, height, and vital signs, ensuring accurate health assessments.
- Recorded and monitored patients' temperature, pulse, and blood pressure to support timely medical interventions.
- Managed comprehensive patient records, documenting histories, vitals, and assessments to facilitate coordinated care.
- Interviewed patients to obtain medical information, weight and height measurements and vital signs.
- Took and recorded patients' temperature, pulse and blood pressure.
RN Supervisor (Contract)- SNF
1 Month- Administered medications and treatment to patients and monitored response to treatments while working with healthcare teams to adjust care plans.
- Recorded patients' temperature, pulse, and blood pressure to monitor health status.
- Managed comprehensive patient records, ensuring accuracy in histories, vitals, and assessments for effective care.
- Interviewed patients to obtain medical information, weight and height measurements and vital signs.
- Documented all nursing assessments, including treatments, medications, IVs, discharge instructions, and follow-up care for continuity of care.
RN Supervisor (Contract) - SNF
3 Months- Resolved client requests and internal operational issues to enhance service delivery.
- Conducted facility surveys and inspections by authorized governmental agencies.
- Monitored Infection Control and Critical Incidents, Risk Management and Quality Improvement plans.
- Monitored infection control, critical incidents, risk management, and quality improvement plans to uphold patient safety.
- Assisted in resolving and satisfying client requests and internal operational issues.
Assistant Director (Contract) - SNF
1 Month- Review potential patient inquires
- Participate in the hiring process and managed team of medical support personnel.
- Conducted facility surveys and inspections for authorized governmental agencies.
- Coordinated with nursing staff to process and direct patients to the appropriate departments
- Monitored infection control, critical incidents, risk management, and quality improvement plans to ensure patient safety and care standards.
- Developed departmental goals, objectives, standards of performance, policies, and procedures to enhance operational effectiveness.
- Improved delivery of patient care through reviewing and implementing improvements to clinical approaches.
- Managed patient case files and coordinated care plans.
Travel RN/ Registry Medical/ Surgical RN (Contract)- Acute
4 Months- Administered medications and treatment to patients and monitored response to treatments while working with healthcare teams to adjust care plans.
- Accurately documented all elements of nursing assessment, including treatment, medications and IVs administered, discharge instructions and follow-up care.
- Managed patient records, ensuring accurate documentation of histories, vitals, and assessments to support quality care.
- Administered medications and treatment to patients and monitored the response to treatments while working with healthcare teams to adjust care plans.
- Documented nursing assessments, including treatments, medications, IVs administered, discharge instructions, and follow-up care for comprehensive patient management.
Clinical Nurse (Contract)
7 Months- Administered immunizations to all age groups in clinical settings.
- Obtained pertinent data (demographics, vital signs, past medical history, physical assessment) to inform care decisions
- Educate on family planning
- Assist with Birth control implant and minor procedures
- Educated patients on family planning options to promote informed reproductive choices
- Counseled patients on reproductive health issues and wellness to enhance understanding and self-management
- Case Management (Medication Reconciliation; Follow up appointments, Test results, DME)
Medical Surgical Nurse (Contract)
3 Months- Interviewed patients to gather medical information, including weight, height, and vital signs, ensuring accurate health assessments.
- Took and recorded patients' temperature, pulse, and blood pressure, contributing to ongoing monitoring of patient health.
- Managed patient records, documenting histories, vitals, and assessments to maintain thorough and accessible patient information.
- Interviewed patients to obtain medical information, weight and height measurements and vital signs.
- Took and recorded patients' temperature, pulse and blood pressure.
Nursing House Supervisor (Full time)- LTAC
2 Years 3 Months- Ensured compliance with laws and regulations, maintaining adherence to Medicare and Medicaid standards.
- Oversaw infection control and critical incidents, implementing procedural changes to enhance patient safety.
- Coordinated patient flow, admissions, and discharges to maintain smooth facility operations.
- Supervised nursing staff, delegated assignments, and supported clinical coverage across units.
- Assessed staffing needs and adjusted schedules to maintain safe patient care.
RN HOUSE SUPERVISOR, CLINICAL MANAGER (Full time) SNF
2 Years 5 Months- Resolved client requests and internal operational issues to enhance service delivery.
- Participated in facility surveys and inspections made by authorized governmental agencies.
- Investigated and reported issues relating to patient care or conditions that might hinder patient well-being.
- Monitored infection control, critical incidents, risk management, and quality improvement plans to ensure patient safety and compliance.
- Developed patient care plans, including assessments, evaluations and nursing diagnoses.
- Improved delivery of patient care through reviewing and implementing improvements to clinical approaches.
- Educated staff on state and federal statutes, rules, and regulations to maintain compliance and improve care standards.
- Managed a variety of patient cases to ensure appropriate care coordination.
Assistant Director Of Patient Clinical Services (Full time)- Home Health
2 Years 11 Months- Resolved client requests and internal operational issues to enhance service delivery.
- Conducted hiring processes, facility surveys, and inspections by authorized governmental agencies.
- Monitored Infection Control and Critical Incidents, Risk Management and Quality Improvement plans.
- Monitored infection control, critical incidents, risk management, and quality improvement plans to uphold patient safety and care standards.
- Assisted in resolving and satisfying client requests and internal operational issues.
- Participated in hiring process; facility surveys and inspections made by authorized governmental agencies.
- Managed case processes for patient admissions, discharges, and utilization reviews.
- Performed medical coding for accurate billing and record-keeping.
Medical Surgical Nurse (Contract)- Acute
7 Months- Interviewed patients to gather comprehensive medical information, including weight, height measurements, and vital signs for accurate assessments.
- Took and recorded patients' temperature, pulse, and blood pressure to monitor health status and inform treatment decisions.
- Managed detailed patient records, documenting patient histories, vital signs, and assessments to ensure continuity of care.
- Interviewed patients to obtain medical information, weight and height measurements and vital signs.
- Took and recorded patients' temperature, pulse and blood pressure.
Rehabilitation Registered Nurse (Contract) - Acute
5 Months- Administered medications and treatment to patients and monitored response to treatments while working with healthcare teams to adjust care plans.
- Recorded patients' temperature, pulse, and blood pressure to support accurate health assessments.
- Managed patient records, ensuring comprehensive documentation of histories, vitals, and assessments for continuity of care.
- Interviewed patients to obtain medical information, weight and height measurements and vital signs.
- Documented nursing assessments, including treatments, medications, IVs, discharge instructions, and follow-up care to maintain clear communication among healthcare teams.
Nursing Supervisor (Full time)- SNF
1 Year 2 Months- Conducted patient interviews to gather medical information, including vital signs, weight, and height.
- Managed detailed patient records, including patient histories, vitals and assessments.
- Accurately documented all elements of nursing assessment, including treatment, medications and IVs administered, discharge instructions and follow-up care.
- Provided wound care to patients, ensuring proper treatment protocols were followed.
- Interviewed patients to obtain medical information, weight and height measurements and vital signs.
- Provided direct nursing care to patients during staffing shortages.
- Oversaw nursing staff, both licensed and non-licensed, to maintain high standards of patient care.
Education
BS - Nursing
Skills
Utilization review expertise
Proficient in case management practices
Interqual and MCG proficiency
Patient care coordination
Care plan development
Veteran registered nurse
Medical-surgical nursing experience
Medical-surgical telemetry experience
Experience in a hospital setting
Electronic medical records
Healthcare industry expertise
Experienced manager
Home health experience
Critical thinking
Accomplishments
- Achieved 100% by completing Inpatient reviews with accuracy and efficiency.
Certification
- Licensed RN - 16 YEARS
Languages
English
Timeline
Inpatient Nurse Case Manager
Medpoint Management
08.2026 - CurrentRead More
Utilization Manager- Managed Care
Molina Healthcare Inc
09.2021 - 01.2026Read More
Utilization Manager (Contract)- Military Treatment Facility
Distinctive Home and Health Care- 30th Medical Group Vandenberg Air Force Base
09.2020 - 09.2021Read More
RN Case Management (Contract) Calibrated Healthcare Management
ELITE NURSING SERVICES
10.2019 - 12.2019Read More
Travel Medical/Surgical/Telemetry RN (Contract)- Acute
Guam Regional Medical City
04.2019 - 07.2019Read More
Registered Nurse
AUFMC MEDICAL MISSION
01.2019 - 09.2020Read More
Clinical Nurse (Contract) – Primary Care
Innovage PACE San Bernardino Center
10.2017 - 03.2019Read More
Medical Surgical Nurse (Contract)- LTAC
Kindred Hospital
09.2017 - 10.2017Read More
RN Supervisor (Contract)- SNF
Glendale Health Care Center
08.2017 - 09.2017Read More
RN Supervisor (Contract) - SNF
Broadway Health Care Center
05.2017 - 08.2017Read More
Assistant Director (Contract) - SNF
Valle Verde - SNF
04.2017 - 05.2017Read More
Travel RN/ Registry Medical/ Surgical RN (Contract)- Acute
Ventura County Medical Center
12.2016 - 04.2017Read More
Clinical Nurse (Contract)
California Department Of Public Health
05.2016 - 12.2016Read More
Medical Surgical Nurse (Contract)
Kindred Healthcare Inc
05.2016 - 08.2016Read More
Nursing House Supervisor (Full time)- LTAC
Kindred Healthcare Inc
02.2014 - 05.2016Read More
RN HOUSE SUPERVISOR, CLINICAL MANAGER (Full time) SNF
Thousand Oaks Healthcare Center
03.2012 - 08.2014Read More
Medical Surgical Nurse (Contract)- Acute
Ventura County Medical Center
09.2011 - 04.2012Read More
Rehabilitation Registered Nurse (Contract) - Acute
Cottage Rehabilitation Hospital
04.2011 - 09.2011Read More
Assistant Director Of Patient Clinical Services (Full time)- Home Health
Braewood Home Health Inc
05.2010 - 04.2013Read More
Nursing Supervisor (Full time)- SNF
Glenwood care Center
05.2010 - 07.2011Read More
Angeles University Foundation
BS from Nursing
Read More