Jayson Ryan Batto
Asheville,United States
Summary
Registered Nurse and analyst with experience in psychiatric care, utilization review, and MHPAEA NQTL compliance. Combines clinical assessment, policy review, and cross-functional coordination to support medical necessity decisions, regulatory alignment, and continuity of care.
Overview
19
19
years of professional experience
Work History
Registered Nurse
PruittHealth-Brevard
Brevard, NC
06.2024 - Current
- Developed and implemented individualized care strategies for patients with complex chronic conditions, improving recovery outcomes.
- Conduct comprehensive patient assessments including biophysical, psychosocial, and environmental factors to formulate individualized care plans.
- Monitored patients' vital signs and mental health status, promptly identifying changes requiring intervention.
- Administer medications, injections, and perform wound care following established protocols and safety guidelines.
- Collaborated with interdisciplinary healthcare teams to coordinate patient care and facilitate discharge planning.
- Provide education and support to patients and their families regarding health management and treatment options.
- Advocate for patients by communicating effectively with doctors and family members, ensuring patient needs and preferences are respected.
- Utilize electronic health records (EHR) to document patient care accurately and streamline communication among medical staff.
Registered Nurse-Analyst for MHPAEA NQTL
Willis Towers Watson Global Business, Inc. H&B NA
02.2022 - 01.2024
- Developed and implemented protocols ensuring compliance with MHPAEA Non-Quantitative Treatment Limitations (NQTL) requirements across medical and pharmacy benefits, enhancing regulatory adherence.
- Conducted comprehensive reviews of Utilization Management policies, including Prior-authorization, Concurrent Review, and Post-service Review in mental health and substance use disorder services, identifying areas for policy improvement.
- Collaborate with legal, clinical, and compliance teams to assess and update vendor policies, ensuring alignment with federal and state parity regulations.
- Analyze discrepancies between mental health/substance use disorder (MH/SUD) and medical/surgical (M/S) service management to recommend corrective actions.
- Provide training and support to internal stakeholders and external vendors on MHPAEA NQTL standards and implementation strategies.
- Generated detailed reports and data analysis on parity compliance findings, facilitating continuous quality improvement and supporting regulatory reporting initiatives.
Nurse Medical II (USRN)
Legato Technology Health Philippines, Inc.
12.2020 - 01.2022
- Analyzed Utilization Management policies for post-service/retrospective review of outpatient services and inpatient length of stay to ensure compliance and improve care delivery.
- Review for Post-Service of the Outpatient Services that requires authorization using medical policies/clinical criteria/clinical guidelines (e.i., MCG and Interqual), Federal and state mandates.
- Assist departmental personnel with issues related to coding (ICD-10/CPT/HCPC), authorizations, NCQA/URAC standards.
- Interacted with providers or external facilities to gather clinical information for the medical necessity review process and care planning.
- Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency and communication.
- Prepares clinical reviews based on clinical guidelines and provides monitoring of cases involving medical and quality of care decisions. Presents recommendations based on clinical review, clinical criteria and organizational policies to physicians/ medical directors for final determination.
- Assisted team members by facilitating effective communication and collaboration. and facilitated working relationships with Medical Directors on CM and UM cases.
- Conducted detailed analyses of Utilization Management policies, including Prior authorization, Concurrent review, and Post-service review to assess alignment with regulations for Skilled Nursing Facility and/or level of care admission request.
- Review the services that require Prior Authorization, Concurrent Review and Post-Service using medical policies/clinical criteria/clinical guidelines (e.i., MCG and Interqual), Federal and state mandates.
- Assist departmental personnel with issues related to coding (ICD-10/CPT/HCPC), authorizations, NCQA/URAC standards.
- Interact with providers or external facilities as needed to gather clinical information to support the medical necessity review process and plan of care.
- Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency and communication.
- Led cross-disciplinary reviews of complex admission requests, aligning clinical rationale with care pathways to enhance decision quality and continuity of care.
- Prepares clinical reviews based on clinical guidelines and provides monitoring of cases involving medical and quality of care decisions. Presents recommendations based on clinical review, clinical criteria and organizational policies to physicians/ medical directors for final determination.
- Ability to assist and facilitate working relationships with Medical Directors on CM and UM cases.
- Conducted detailed analyses of Utilization Management policies for Prior-Authorization of Outpatient Services.
- Review for Prior-Authorization of the Outpatient Services that require precertification using medical policies/clinical criteria/clinical guidelines (e.g., MCG and Interqual), Federal and state mandates.
- Assist departmental personnel with issues related to coding (ICD-10/CPT/HCPC), authorizations, NCQA/URAC standards.
- Interact with providers or external facilities as needed to gather clinical information to support the medical necessity review process and plan of care.
- Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency and communication.
- Spearhead cross-disciplinary reviews of complex admission requests to align clinical rationale with care pathways, improving decision quality and continuity of care.
- Prepares clinical reviews based on clinical guidelines and provides monitoring of cases involving medical and quality of care decisions. Presents recommendations based on clinical review, clinical criteria and organizational policies to physicians/ medical directors for final determination.
- Ability to assist and facilitate working relationships with Medical Directors on CM and UM cases.
- Assessed call disposition patterns to identify service gaps, introduced targeted process adjustments, and delivered noticeable improvements in resolution consistency.
- Developed proactive outreach workflows for at-risk members, aligning clinical priorities with care teams to enhance member engagement and ensure continuity of care.
- Developed concise call-summary templates to standardize information capture, improving clarity for case managers and enabling smoother follow-up actions.
- Facilitated daily huddles with case management to prioritize urgent member needs, streamlining resource allocation and improving timeliness of interventions.
- Spearheaded customer retention initiatives by redesigning follow-up workflows, improving repeat engagement and strengthening brand trust through proactive outreach.
- Coordinated cross-functional handoffs with technical teams to resolve complex cases, shortening resolution cycles and improving customer satisfaction outcomes.
- Maintained accurate case documentation and tracked resolution steps to ensure compliance and provide clear handover notes for ongoing support continuity.
- Coordinated with underwriting and claims teams to clarify policy terms for callers, enabling quicker approvals and strengthening interdepartmental handoffs.
- Introduced a tiered inquiry-routing approach to prioritize complex insurance claims, improving resolution focus and producing noticeable reductions in escalation workload.
- Reviewed caller histories to identify recurring pain points, proposing process adjustments that led to measurable improvements in first-contact clarity.
- Managed follow-ups and tracked outstanding documentation to accelerate claims progression, contributing to steadier case throughput and customer reassurance.
- Designed streamlined underwriting checklists to accelerate decision flow, reducing manual back-and-forth and producing more consistent application outcomes.
- Assessed borrower financials and collateral with structured models, identifying risk patterns that guided more precise approval recommendations.
- Coordinated with credit ops and branch teams to close complex files faster, improving case throughput and enhancing client turnaround.
- Verified documentation and flagged discrepancies through systematic audits, ensuring compliance and preventing downstream processing delays.
- Established clear risk criteria for non-standard applications, enabling consistent decisions and reducing escalation cycles.
- Redesigned call triage workflow to route complex fraud cases to specialists faster, improving resolution speed and reducing repeat escalations with clearer case context.
- Reviewed complaint patterns to identify recurring fraud methods, compiling reports that informed prevention measures and strengthened verification checks.
- Coordinated cross-department handoffs with investigations and billing teams to accelerate complaint processing, yielding more timely outcomes for affected customers.
- Maintained comprehensive case logs and audit trails for suspected fraudulent transactions, ensuring traceability and compliance with internal review policies.
- As a Psychiatric Nurse, dealt with clients diagnosed with Mental Health Disorders and/or Substance Use Disorders.
- Conduct comprehensive patient assessments including physical, psychosocial, and environmental factors to develop personalized care plans.
- Administer medications, injections, and perform wound care following strict protocols to ensure patient safety.
- Monitor vital signs and mental health status to detect and respond to changes in patient condition promptly.
- Collaborate with interdisciplinary healthcare teams to coordinate effective patient care and discharge planning.
- Provide patient and family education on health management, treatment options, and post-care instructions.
- Advocate for patient needs by effectively communicating with interdisciplinary teams, patients, and families to ensure holistic and respectful care.
- Develop individualized care strategies for patients with complex chronic conditions to promote improved health outcomes.
- Resolved complex provider billing disputes by investigating records and coordinating with claims teams, reducing follow-up cycles and improving provider satisfaction.
- Coordinated cross-team case escalations with clinical and claims departments to expedite approvals, strengthening interdepartmental response times and continuity of care.
- Analyzed recurring inquiry patterns to recommend workflow adjustments, leading to noticeable reductions in repeat calls and smoother case resolution.
- Conduct comprehensive patient assessments to support individualized care planning.
- Administer medications and perform wound care under supervision, adhering to safety protocols.
- Monitor vital signs and recognize changes in patient conditions for timely reporting.
- Assist patients with activities of daily living to promote comfort and recovery.
- Collaborate with healthcare team members to coordinate patient care and facilitate communication.
- Document patient care accurately using electronic health records to maintain up-to-date medical information.
- Observe and assist in the implementation of care plans tailored to patients' specific health needs and recovery goals.
- Assist in the rapid assessment and prioritization of emergency patients to ensure timely and appropriate care in the ER and OPD settings.
- Support the administration of emergency medications and treatments under the supervision of senior nursing staff.
- Monitor and document patients' vital signs and symptoms continuously to identify critical changes promptly.
- Provide patient and family education on post-emergency care and follow-up procedures to promote recovery and prevent complications.
- Maintain sterile techniques and prepare emergency equipment and supplies for immediate use.
- Perform comprehensive patient assessments in the ER-OPD setting to develop immediate care plans tailored to patients' urgent needs.
- Coordinate and implement nursing care protocols for trauma, acute illnesses, and minor surgical procedures in emergency and outpatient departments.
- Perform independent and dependent nursing procedures specific to emergency and outpatient department patients, ensuring adherence to safety protocols.
- As a registered nurse I work alongside other healthcare professionals in performing patient assessments and recording vital signs to monitor patient health.
- Administering medications and basic wound care, ensuring adherence to safety protocols.
- Assisted patients with daily living activities to promote comfort and recovery. with daily living activities such as hygiene, mobility, and feeding to promote comfort and independence.
- Engaged in patient education by providing information on healthcare plans and disease management. by providing information about health care plans and disease management under the guidance of licensed nurses.
- Conducted initial patient assessments to gather baseline data for care planning. to collect baseline data and observe for any abnormalities under supervision.
- Assist in the implementation of individualized nursing care plans developed by registered nurses to support patient recovery.
- As a registered nurse I work alongside other healthcare professionals in performing patient assessments and recording vital signs to monitor patient health.
- Administering medications and basic wound care, ensuring adherence to safety protocols.
- Help patients with daily living activities such as hygiene, mobility, and feeding to promote comfort and independence.
- Participate in patient education by providing information about health care plans and disease management under the guidance of licensed nurses.
- Perform initial patient assessments to collect baseline data and observe for any abnormalities under supervision.
- Assist in the implementation of individualized nursing care plans developed by registered nurses to support patient recovery.
- Initiated proactive outreach to high-value accounts to anticipate service needs, improving retention through tailored resolution paths and strengthened client relationships.
- Mentored new hires on back-of-house procedures and quality standards, accelerating onboarding and maintaining consistent service delivery during peak periods.
- Audited customer records and reconciled discrepancies using internal CRM workflows, delivering noticeable improvements in data integrity and follow-up accuracy.
Registered Nurse-Analyst
Shearwater Health Services Inc.
08.2019 - 12.2020
- Conducted detailed analyses of Utilization Management policies, including Prior authorization, Concurrent review, and Post-service Review to assess alignment with regulations for Skilled Nursing Facility and/or level of care admission request.
- Review the services that require Prior Authorization, Concurrent Review and Post-Service using medical policies/clinical criteria/clinical guidelines (e.i., MCG and Interqual), Federal and state mandates to determine medical necessity of the services and procedures.
- Delivered bedside nursing care for Shearwater Health Services patients
- Administered medications and monitored patient responses
- Documented assessments, treatments, and care plans in clinical records
Registered Nurse-Senior Analyst
Accenture
01.2017 - 08.2019
- Conducted detailed analyses of Utilization Management policies for Prior- Authorization of Outpatient Services. Reviewed prior-authorization requests for outpatient services, including durable medical equipment, to confirm adherence to clinical guidelines and regulatory mandates.
- Delivered patient assessments and clinical triage for Accenture health programs.
- Coordinated care plans with providers, case managers, and internal teams.
- Documented nursing notes in electronic health records and care systems.
Registered Nurse-Analyst
Accenture
11.2015 - 12.2016
- Designed proactive outreach workflows for at-risk members, aligning clinical priorities with care teams to advance engagement and improve continuity of care.
- Facilitated daily huddles with case management to prioritize urgent member needs, streamlining resource allocation and increasing timeliness of interventions.
- Developed concise call-summary templates to standardize information capture, clarifying communication for case managers and enabling effective follow-up actions.
- Assessed call disposition patterns to identify service gaps and introduced targeted process adjustments, enhancing resolution consistency.
Customer Care Assistant
Xerox
03.2015 - 11.2015
- Spearheaded customer retention initiatives by redesigning follow-up workflows, enhancing repeat engagement and reinforcing brand trust through proactive outreach.
- Coordinated cross-functional handoffs with technical teams to resolve complex cases, reducing resolution cycles and elevating customer satisfaction.
- Maintained accurate case documentation and tracked resolution steps to ensure compliance and facilitate clear handover notes for ongoing support.
Customer Service Associate
Manulife Data Services
05.2014 - 10.2014
- Coordinated with underwriting and claims teams to clarify policy terms for callers,
- Introduced tiered inquiry-routing approach to prioritize complex insurance claims, enhancing resolution focus and reducing escalation workload.
- Enhanced focus on resolving issues by implementing structured communication strategies.
- Reviewed caller histories to identify recurring pain points, recommending process adjustments that improved first-contact clarity.
- that led to measurable improvements in first-contact clarity.
- Managed follow-ups and tracked outstanding documentation to expedite claims progression, contributing to steadier case throughput and increased customer reassurance.
- progression, contributing to steadier case throughput and customer reassurance.
- enabling quicker approvals and strengthening interdepartmental handoffs.
Credit Underwriter
HSBC-Techno Hub
07.2013 - 04.2014
- Assessed borrower financials and collateral with structured models, identifying risk patterns that guided more precise approval recommendations.
- Designed streamlined underwriting checklists to accelerate decision flow, reducing manual back-and-forth and producing more consistent application outcomes.
- Coordinated with credit ops and branch teams to expedite closure of complex files, enhancing case throughput and client turnaround.
- Verified documentation and flagged discrepancies through systematic audits, ensuring compliance and preventing processing delays.
- Established clear risk criteria for non-standard applications, enabling consistent decisions.
- and reducing escalation cycles.
Customer Service Representative (Complaints dept.)
IBM - Daksh Techno Hub
01.2013 - 05.2013
- Redesigned call triage workflow to route complex fraud cases to specialists faster, improving resolution speed and reducing repeat escalations with clearer case context.
- Analyzed complaint patterns to identify recurring fraud methods, producing reports that guided prevention measures and enhanced verification checks.
- Facilitated cross-department handoffs with investigations and billing teams to expedite complaint processing, resulting in quicker resolutions for affected customers.
- Maintained comprehensive case logs and audit trails for suspected fraudulent transactions. ensuring traceability and compliance with internal review policies.
Registered Nurse
National Center for Mental Health
11.2011 - 12.2012
- Managed care for clients with mental health and substance use disorders, fostering therapeutic relationships to support recovery.
- Conduct comprehensive patient assessments including physical, psychosocial, and environmental factors to develop personalized care plans.
- Administer medications, injections, and perform wound care following strict protocols to ensure patient safety.
- Monitor vital signs and mental health status to detect and respond to changes in patient condition promptly.
- Collaborate with interdisciplinary healthcare teams to coordinate effective patient care and discharge planning.
- Educated patients and families on health management, treatment options, and post-care instructions, enhancing understanding and compliance.
- Advocated for patient needs through effective communication with interdisciplinary teams, patients, and families, ensuring holistic care approaches.
- Develop individualized care strategies for patients with complex chronic conditions to promote improved health outcomes.
Senior Customer Service Associate (Health Care Insurance)
Convergys Service Incorporated - San Lazaro
04.2011 - 12.2011
- Coordinated cross-team case escalations with clinical and claims departments to expedite approvals, improving interdepartmental response times.
- Resolved complex provider billing disputes through thorough record investigations and claims team coordination, enhancing provider satisfaction.
- Analyzed recurring inquiry patterns to recommend workflow adjustments, resulting in reduced repeat calls and streamlined case resolution.
Nurse Trainee
Ospital ng Sampaloc
12.2010 - 03.2011
- Conducted comprehensive patient assessments to inform and enhance individualized care planning.
- Administer medications and perform wound care under supervision, adhering to safety protocols.
- Monitor vital signs and recognize changes in patient conditions for timely reporting.
- Assist patients with activities of daily living to promote comfort and recovery.
- Collaborated with healthcare team members to streamline patient care coordination and improve communication.
- Document patient care accurately using electronic health records to maintain up-to-date medical information.
- Assisted in implementing tailored care plans to address patients' specific health needs and support recovery goals.
Registered Nurse
Mary Chiles Gen. Hospital
03.2010 - 07.2010
- Performed comprehensive patient assessments in ER-OPD, developing immediate care plans tailored to patients' urgent needs.
- Coordinate and implement nursing care protocols for trauma, acute illnesses, and minor surgical procedures in emergency and outpatient departments.
- Assisted in rapid assessment and prioritization of emergency patients, ensuring timely and appropriate care in ER and OPD settings.
- Monitor and document patients' vital signs and symptoms continuously to identify critical changes promptly.
- Support administration of emergency medications and treatments, enhancing patient care under supervision of senior nursing staff.
- Maintain sterile techniques and prepare emergency equipment and supplies for immediate use.
- Provide patient and family education on post-emergency care and follow-up procedures to promote recovery and prevent complications.
- Perform independent and dependent nursing procedures specific to emergency and outpatient department patients, ensuring adherence to safety protocols.
Registered Nurse
Ospital ng Sampaloc
10.2009 - 01.2010
- Collaborated with healthcare professionals to perform patient assessments and record vital signs, ensuring effective monitoring of patient health.
- Perform initial patient assessments to collect baseline data and observe for any abnormalities under supervision.
- Administering medications and basic wound care, ensuring adherence to safety protocols.
- Assist in the implementation of individualized nursing care plans to support patient recovery.
- Assisted patients with daily living activities, including hygiene, mobility, and feeding, to enhance comfort and promote independence.
- Provided patient education on healthcare plans and disease management, supporting informed decision-making under the guidance of licensed nurses.
Registered Nurse
Ospital ng Tondo
07.2009 - 08.2009
- Collaborated with healthcare professionals to perform patient assessments and record vital signs, ensuring accurate monitoring of patient health.
- Administering medications and basic wound care, ensuring adherence to safety protocols.
- Conducted initial patient assessments to collect baseline data and identify abnormalities under supervision.
- Assist in the implementation of individualized nursing care plans developed by registered nurses to support patient recovery.
- Assisted patients with daily living activities, including hygiene, mobility, and feeding, to promote comfort and independence.
- Educated patients on healthcare plans and disease management.
Customer Service Associate Back of House Associate
Telstra Australian Telecommunications
09.2007 - 05.2009
- Initiated proactive outreach to high-value accounts to anticipate service needs, improving retention through tailored resolution paths and strengthened client relationships.
- Mentored new hires on back-of-house procedures and quality standards, enhancing onboarding process and ensuring consistent service delivery during peak periods.
- Audited customer records and reconciled discrepancies through internal CRM workflows, improving data integrity and follow-up accuracy.
Education
Bachelor of Science - Nursing
Angeles University Foundation
Angeles City04-2007
Skills
- Registered Nurse
- Clinical assessment
- Patient care
- Patient-centered planning
- Comprehensive assessment
- Utilization management
- Clinical compliance
- Clinical necessity
- Clinical data analysis
- Case management
- Care coordination
- Patient education
- Patient consultation
- Therapeutic planning
- Chronic care management
- Diabetes management
- Patient triage
- Medical assessment
- Pediatric care
- Referral coordination
- Advanced life support
- Activities of daily living
- EHR management
- Electronic documentation
- Policy evaluation
- Interdisciplinary collaboration
- Effective communication
- Team Player
- Work under pressure
- Critical thinking
- Independent execution
- Microsoft Office
- Microsoft Excel
- Administrative tasks
- Health education
- Bilingual communication
- Activities of daily living
- Clinical decision-making
- Clinical mentoring
- Patient triage
- Clinical mentoring
Personal Information
Title: Registered Nurse- North Carolina and Compact States
Languages
Tagalog, English
Courses
- Hemodialysis Nurse Training Program, Jun 2024
- Hemodialysis Nurse Training Program
Timeline
Registered Nurse
PruittHealth-Brevard
06.2024 - Current
Registered Nurse-Analyst for MHPAEA NQTL
Willis Towers Watson Global Business, Inc. H&B NA
02.2022 - 01.2024
Nurse Medical II (USRN)
Legato Technology Health Philippines, Inc.
12.2020 - 01.2022
Registered Nurse-Analyst
Shearwater Health Services Inc.
08.2019 - 12.2020
Registered Nurse-Senior Analyst
Accenture
01.2017 - 08.2019
Registered Nurse-Analyst
Accenture
11.2015 - 12.2016
Customer Care Assistant
Xerox
03.2015 - 11.2015
Customer Service Associate
Manulife Data Services
05.2014 - 10.2014
Credit Underwriter
HSBC-Techno Hub
07.2013 - 04.2014
Customer Service Representative (Complaints dept.)
IBM - Daksh Techno Hub
01.2013 - 05.2013
Registered Nurse
National Center for Mental Health
11.2011 - 12.2012
Senior Customer Service Associate (Health Care Insurance)
Convergys Service Incorporated - San Lazaro
04.2011 - 12.2011
Nurse Trainee
Ospital ng Sampaloc
12.2010 - 03.2011
Registered Nurse
Mary Chiles Gen. Hospital
03.2010 - 07.2010
Registered Nurse
Ospital ng Sampaloc
10.2009 - 01.2010
Registered Nurse
Ospital ng Tondo
07.2009 - 08.2009
Customer Service Associate Back of House Associate
Telstra Australian Telecommunications
09.2007 - 05.2009
Bachelor of Science - Nursing
Angeles University Foundation