Lisa Rodriguez
Patterson,CA
Summary
I am a Registered Nurse currently working as a concurrent review nurse. I am hardworking and reliable. I have experience in the acute care setting, working in a face paced environment. I also have experience working in a skilled nursing facility and correctional facilities. Working as a Concurrent review nurse I have become familiar with managed care, Medi-Cal and community support programs that can be beneficial to our patients. I have experience with MCG guidelines and InterQual and I am familiar with Software such as Essette and Jiva.
Overview
16
16
years of professional experience
Work History
RN
Memorial Medical Center
Modesto, CA
01.2021 - 01.2022
- Monitored and recorded patient condition, vital signs, recovery progress and medication side effects.
- Assessed patients' response to treatment and suggested ways to combat side effects.
- Maintained personal and team compliance with medication administration standards and patient care best practices.
- Collected lab specimens, ordering and interpreting diagnostic tests and lab results.
- Acted as patient advocate and implemented total patient care through team nursing process.
- Performed blood and blood product transfusions and intravenous infusions to address patient symptoms or underlying causes.
- Administered medications, tracked dosages and documented patient conditions.
LVN
Wellpath
Merced, CA
06.2019 - 01.2020
- Monitored infection control procedures to verify facility-wide health and safety.
- Collected biological samples for routine laboratory testing to assist diagnostic processes.
- Charted changes in patient conditions and discussed concerns with supervising healthcare provider.
- Addressed patient care needs, collected vitals, dressed wounds and managed catheters.
- Administered prescribed medications, insulin injections and IM injections
ACNA
Memorial Medical Center
Modesto, CA
05.2008 - 11.2020
- Managed supplies and restocked inventory to ensure optimal availability for patient care.
- Documented patient intake and dietary requirements, also assisting with feeding and monitoring.
- Promoted patient satisfaction by assisting with daily living needs such as bathing, dressing, toileting and exercising.
- Collected specimens, monitored vitals and maximized patient comfort to maintain optimal environment.
Concurrent Review Nurse
Health Plan of San Jaoquin
Lathrop, CA
10.2021 - Current
- Determined medical necessity and cost-effectiveness of services through utilization review processes.
- Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
- Referred cases to secondary review for failure to meet MCG criteria.
- Reviewed patient admissions to determine medical necessity as directed by MCG criteria.
- Collaborated with physicians and other healthcare providers to ensure accurate coding and billing practices.
- Interpreted clinical data from medical records and applied evidence-based criteria in order to make decisions regarding the appropriateness of care provided.
- Utilized knowledge of the principles of managed care organizations while performing concurrent review activities.
- Researched complex cases involving multiple diagnoses or treatments requiring coordination among multiple providers.
- Reviewed requests for prior authorization by gathering pertinent information from medical records, insurance policies, provider notes., in order to make an informed decision about treatment plans.
RN Supervisor
San Luis Care Center
Newman
01.2024 - Current
- Provided clinical leadership and direction for nursing staff, ensuring that all tasks were completed in accordance with accepted standards of care.
- Developed and implemented policies to ensure the safety and well-being of patients, their families, and staff members.
- Collaborated with other departments to ensure quality patient care was provided throughout the hospital system.
- Maintained current knowledge of healthcare regulations and best practices in order to promote compliance within the organization.
- Evaluated patient records regularly to identify opportunities for improvement in service delivery.
- Participated in continuing education courses related to advances in nursing practice.
- Served as an active member on committees focused on improving quality initiatives at the facility level.
- Cultivated positive relationships with patients and families, addressed concerns or complaints, monitored patient satisfaction survey data and maintained confidentiality of patient information.
- Developed, implemented and adjusted patient care plans in response to new symptoms or developments.
- Observed and interpreted patients' symptoms, devised individualized care plans, delivered best and most suitable care and advice and communicated to nursing staff and physicians.
- Audited and completed charts, evaluations and medical forms.
- Reviewed and completed admission and discharge assessments.
Education
Associate of Science - Nursing
Gurnick Academy of Medical Arts
Fresno, CA09.2020
Bachelor of Science -
Gurnick Academy of Medical Arts
Concord, CA12.2021
Skills
- Intravenous Therapy and Blood Withdrawal Certification
- Communications
- Organization
- Planning and coordination
- Customer service
- Advanced Cardiac Life Support (ACLS) certification
- Epic EHR Management
- Utilization review
- Discharge Planning
- Community health
- Care Planning
- Case Management
- Wound Care
- Medicaid knowledge
- Healthcare regulations
- Records analysis
- Utilization Management
- HIPAA Compliance
- Insurance Verification
Timeline
RN Supervisor
San Luis Care Center
01.2024 - Current
Concurrent Review Nurse
Health Plan of San Jaoquin
10.2021 - Current
RN
Memorial Medical Center
01.2021 - 01.2022
LVN
Wellpath
06.2019 - 01.2020
ACNA
Memorial Medical Center
05.2008 - 11.2020
Associate of Science - Nursing
Gurnick Academy of Medical Arts
Bachelor of Science -
Gurnick Academy of Medical Arts