Jackielyn Saliba
National City,CA
Summary
Comprehensive background in nursing, utilization management, and medical records, along with a commitment to ensuring optimal patient care through effective collaboration and utilization of healthcare resources. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Prior Auth Outpatient Utilization Review Case Mgr. - Licensed Vocational Nurse
Care1st/BlueShield of California - Promise Health Plan
10.2016 - 01.2024
- Assess, coordinate, monitor, and evaluate individual health needs, collaborating with patients' physicians and contracted ancillary services
- Review prior authorization cases, applying correct guidelines based on medical record reviews against clinical criteria such as Medi-Cal, Medicare, MCG, Health Plan and NCCN
- Conduct utilization management reviews across various healthcare departments such as Outpatient, Home Health, DME, CBAS, Long-term Care and Retroactive Cases
- Liaise with out-of-network facilities for clinical information to determine the feasibility of services outside the plan.
Licensed Vocational Nurse - Medication Nurse
Reo Vista HealthCare Center
07.2016 - 10.2016
- Administered medications and provided basic nursing care under RN supervision
- Monitored health changes, demonstrated knowledge of side effects and contraindications of medications, G-Tube feedings, and basic care
- Supervised & assisted CNAs with basic patient care
- Conducted assessments, monitored progress, and documented patient notes.
Medical Record/EMR Specialist
Ron's Pharmacy/Guardian Pharmacy
06.2010 - 07.2016
- Reviewed medical records to correctness & completeness
- Audited MARS & POS for Assisted & Skilled Nursing Facilities, profiling E-mars facilities using Accuflow, Quickmar & ALMSA
- Assisted facilities with medical records issues, ICD-9 codes & verified records for accuracy.
Education
Bachelor of Science in Nursing -
Philippines Women's University - Manila Philippines
01.2006
De La Salle University Health Sciences Institute - Cavite Philippines
01.2004
Skills
- Problem-Solving
- Case Management
- Case Documentation
- Organization and Multitasking
- Documentation And Reporting
- Relationship Building
- Decision-Making
- Conflict Resolution
- Positive Attitude
- Email and Telephone Etiquette
- Care Coordination
- Client Advocacy
- Data Entry and Analysis
- MS Office
- Referral Coordination
- Case Management Tracking
- Patient support
- Interdisciplinary Collaboration
- Utilization review
- Utilization Management
Certification
- California Registered Nurse License
- California Vocational Nurse License
- IV Therapy and Blood Withdrawal Certification
References
- Jakelinee Raygoza, (626) 501-8501
- Nicoleta Radulescu, (858) 776-0939
- Julie Berdeski, (619) 322-4917
Timeline
Prior Auth Outpatient Utilization Review Case Mgr. - Licensed Vocational Nurse
Care1st/BlueShield of California - Promise Health Plan
10.2016 - 01.2024
Licensed Vocational Nurse - Medication Nurse
Reo Vista HealthCare Center
07.2016 - 10.2016
Medical Record/EMR Specialist
Ron's Pharmacy/Guardian Pharmacy
06.2010 - 07.2016
Bachelor of Science in Nursing -
Philippines Women's University - Manila Philippines
De La Salle University Health Sciences Institute - Cavite Philippines