Summary
Overview
Work History
Education
Skills
Timeline
Certifications And Awards
Generic

Joyce Orcullo-domingo

Oxnard,CA

Summary

Experienced Nurse Leader and Case Manager with 10+ years in clinical nursing and 5+ years in utilization management. Proven success in CMS compliance, InterQual-based reviews, discharge planning, and interdisciplinary care coordination. Skilled in staff training, EMR systems, and optimizing healthcare workflows to ensure patient-centered, cost-effective care.

Overview

16
16
years of professional experience

Work History

Manager of Case Management

Seaview IPA / Optum
10.2024 - Current
  • Oversee daily departmental operations to ensure compliance with health plan, CMS, and internal guidelines
  • Lead a multidisciplinary Utilization Management (UM) team to improve workflow and authorization turnaround
  • Collaborate with health plans on performance metrics, trends, and regulatory compliance
  • Handle escalations, respond to plan inquiries, and facilitate data reporting
  • Conduct staff education and training on regulatory updates and documentation standards

Team Lead – Case Management

Seaview IPA / Optum
01.2022 - 10.2024
  • Promoted from case manager to team lead for outstanding performance
  • Supported department operations in manager’s absence
  • Trained newly hired licensed staff and led ongoing training sessions
  • Assisted with health plan communications and integrity reporting
  • Escalated performance issues and participated in resource allocation

Health Services Nurse – Case Manager

Seaview IPA / Optum
10.2015 - 01.2022
  • Conducted initial and continued stay reviews using InterQual criteria
  • Coordinated discharge planning and collaborated with providers
  • Presented cases to medical directors and managed authorization workflows
  • Ensured medical necessity compliance and timely review processing

Registered Nurse – Medical-Surgical/Oncology

Community Memorial Hospital
12.2009 - 10.2015
  • Delivered holistic nursing care and patient education
  • Managed medication administration and documented care plans
  • Supervised staff and performed charge nurse duties
  • Collaborated in interdisciplinary care and end-of-life support
  • Participated in hospital committees to improve patient care

Registered Nurse

Pacific Shores Hospital
08.2009 - 12.2009
  • Assessed patients’ physical, emotional, and psychosocial needs
  • Maintained safety and encouraged therapeutic group participation
  • Coordinated care plans with the healthcare team
  • Provided emotional support and accurate documentation

Education

Bachelor of Science - Nursing

University of Phoenix
08.2014

Associate Degree - Nursing

Ventura College
Ventura, CA
05.2009

Skills

  • Utilization Management
  • Case Management
  • InterQual & MCG Criteria
  • CMS & Health Plan Compliance
  • Electronic Medical Records (EMR)
  • Patient-Centered care
  • Interdisciplinary Collaboration
  • Leadership and Team Management

Timeline

Manager of Case Management

Seaview IPA / Optum
10.2024 - Current

Team Lead – Case Management

Seaview IPA / Optum
01.2022 - 10.2024

Health Services Nurse – Case Manager

Seaview IPA / Optum
10.2015 - 01.2022

Registered Nurse – Medical-Surgical/Oncology

Community Memorial Hospital
12.2009 - 10.2015

Registered Nurse

Pacific Shores Hospital
08.2009 - 12.2009

Associate Degree - Nursing

Ventura College

Bachelor of Science - Nursing

University of Phoenix

Certifications And Awards

  • Registered Nurse License; Expire 12/31/2026
  • Public Health Nurse Certified; Expire 12/31/2026
  • BLS Certified; Expire 09/2027
  • 3rd Quarter Employee Excellence Award, 09/01/15

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