Laura Lucio
EDINBURG
Summary
Registered Nurse with 11 years of hospital experience, including 4 years in a high-acuity NICU setting. Strong background in evaluating medical necessity, ensuring regulatory compliance, and optimizing resource utilization to support quality, cost-effective outcomes. Effective communication with providers and payers. Analytical thinking, precise documentation review, and the ability to bridge clinical care with utilization management standards while maintaining patient advocacy at the forefront. Actively seeking remote nursing opportunities in utilization review and care coordination in a flexible, virtual setting.
Overview
12
12
years of professional experience
Work History
Registered Nurse Case Manager
Doctors Hospital at Renaissance
EDINBURG
01.2014 - Current
Coordinate patient care from admission through discharge, ensuring appropriate level of care and safe transitions. Collaborate with interdisciplinary teams to develop care plans, facilitate discharge planning, and arrange post-acute services. Perform utilization review to support medical necessity, regulatory compliance, and efficient resource management while advocating for patients and families.
Education
Associate Degree in Nursing - Nursing
South Texas College
McAllen, TXSkills
Core Clinical & Coordination Skills
- Care coordination from admission to discharge
- Utilization review & medical necessity determination
- Transitional care management
- Patient and family education
Analytical & Regulatory Skills
- Knowledge of CMS/Medicare & insurance guidelines
- Regulatory compliance
- Documentation & chart review
- Risk assessment
Communication & Leadership Skills
- Strong interdisciplinary communication
- Conflict resolution
- Patient advocacy
- Critical thinking & clinical judgment
- Time management & prioritization
Systems & Administrative Skills
- Electronic Medical Records (EMR) proficiency
- Resource coordination (SNF, rehab, home health, DME)
- Community resource networking
- Experience in use of InterQual and Milliman criteria
Timeline
Registered Nurse Case Manager
Doctors Hospital at Renaissance
01.2014 - Current
Associate Degree in Nursing - Nursing
South Texas College