Jill Orlando
Warren,USA
Summary
Dedicated acute care nurse with expertise in Utilization Review and Case Management, adept at coordinating comprehensive patient care while ensuring efficient resource utilization. Recognized for implementing process improvements that significantly enhanced operational efficiency and quality of care services. Proficient in multitasking, decision-making, and effective communication within multidisciplinary teams to achieve optimal patient outcomes.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Utilization Management Nurse
Blue Cross Blue Shield of MI
REMOTE
10.2022 - 03.2025
- Analyzing medical records to identify potential areas for cost reduction, without compromising patient care.
- Understanding insurance policies and benefits to determine coverage for specific services.
- Communicating effectively with patients, physicians, and other healthcare providers to discuss treatment plans and potential cost implications.
- Knowledge of medical coding and billing practices is necessary to accurately review claims.
- Conducting prospective, concurrent, and retrospective utilization reviews.
- Identifying unnecessary or inappropriate services, and recommending alternative options.
- Documenting review findings and rationale for decisions made.
Emergency Room Case Manager
McLaren Macomb
Mt. Clemens, MI
03.2020 - 10.2022
- Creating personalized treatment plans based on patient needs, including medications, therapies, and follow-up appointments.
- Working with doctors, therapists, social workers, and other healthcare professionals to ensure coordinated care.
- Providing clear information about diagnoses, treatment options, and self-management strategies to patients and their families.
- Coordinating post-discharge care, including home healthcare needs, follow-up appointments, and necessary medical equipment.
- Monitoring and managing healthcare resource usage to ensure cost-effective care.
Emergency Room RN
McLaren Macomb
Mt. Clemens, MI
08.2014 - 03.2020
- Provide emergency medical care to an average of 30 critically ill patients per shift.
- Ensure the provision of quality emergency medical care in accordance with physician orders, hospital policy, and standard nursing practice.
- Perform patient assessment and nursing diagnosis.
- Evaluate episodic and acute responses to physical and psychosocial issues.
- Manage the planning and implementation of interventions.
- Coordinate patient referrals and discharge planning activities.
Med-Surg RN
McLaren Macomb
Mt. Clemens, MI
07.2012 - 08.2014
- Assessed, planned, and implemented the nursing care needs of the patient.
- Carried out physician orders and assisted physicians during procedures.
- Analyzed telemetry strips multiple times a shift.
- Administered prescribed medications, applied dressings, and monitored vital signs.
- Ensured the proper handling of narcotics and specimens.
- Counted narcotics.
- Monitored, recorded, and communicated patient condition as appropriate, utilizing computerized documentation systems.
Education
Bachelor of Science - Nursing
Saginaw Valley State University
Saginaw, MI06-2012
Skills
- Utilization review
- Medical coding
- Treatment planning
- Patient assessment
- Effective communication
- Critical thinking
- Emergency care
- Team collaboration
- Time management
- Creative problem solving
- Microsoft office proficient
- Data analysis
- Discharge planning
- Healthcare resource management
Business References
- Cris Mauro, McLaren Macomb, Previous Manager, Cris.mauro@mclaren.org, 810-358-4815
- Jennifer Amolsch, Blue Cross Blue Shield, Leader of HMO team/Manager, jamolsch@bcbsm.org, 313-655-3337
- Kathy Lanuzza, McLaren Macomb, Coworker, Lanuzza2@msn.com, 586-489-1337
- Mikisha Carson, Utilization Review Nurse, Coworker, mikisha.carson@gmail.com, 231-357-5133
Certification
- MI Registered Nurse License
Timeline
Utilization Management Nurse
Blue Cross Blue Shield of MI
10.2022 - 03.2025
Emergency Room Case Manager
McLaren Macomb
03.2020 - 10.2022
Emergency Room RN
McLaren Macomb
08.2014 - 03.2020
Med-Surg RN
McLaren Macomb
07.2012 - 08.2014
Bachelor of Science - Nursing
Saginaw Valley State University
Similar Profiles
Misty QuirkMisty Quirk
CSR2-claim Specialist at Morley Companies/Blue Cross Blue Shield of MICSR2-claim Specialist at Morley Companies/Blue Cross Blue Shield of MI
Tina M. JenkinsTina M. Jenkins
Senior Analyst at Blue Cross Blue Shield of MISenior Analyst at Blue Cross Blue Shield of MI
Taniya HendleyTaniya Hendley
Customer Service Representative III at Blue Cross Blue Shield of MICustomer Service Representative III at Blue Cross Blue Shield of MI
Nicholas GrossNicholas Gross
Information Security Analyst II at Blue Cross Blue Shield of MIInformation Security Analyst II at Blue Cross Blue Shield of MI
Saleheen MushtaqueSaleheen Mushtaque
Quality Assurance Engineer at Lakeside SoftwareQuality Assurance Engineer at Lakeside Software