Ludivina Holland
Jacksonville,NC
Summary
. Dynamic and results-oriented Concurrent Review Nurse with a proven track record at AmeriHealth Caritas, optimizing resource utilization and enhancing patient outcomes through effective case management and care coordination.
. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
. 36 years of Nursing experience providing high standard of culturally competent care for wide variety of patients with diverse needs.
. 5 Years of clinical concurrent/utilization review experience
Overview
15
15
years of professional experience
1
1
Certification
Work History
Concurrent Review Nurse
AmeriHealth Caritas Family Of Companies
12.2022 - Current
- Conducted comprehensive chart reviews utilizing InterQual criteria to assess medical necessity, ensuring optimal reimbursement levels for services rendered.
- Managed complex cases effectively, coordinating with multidisciplinary teams to ensure seamless delivery of care across
- Works with Medical Director to approve medical determinations or provide recommendations based on requested services and concurrent review findings.
- Accurately maintained records of case management activities following organizational policies and procedures to ensure data integrity for reporting purposes.
Utilization Review Nurse
Onslow Memorial Hospital
06.2019 - 12.2022
- Performed clinical reviews to determine if the medical record documentation supports the need for the service based on clinical criteria, coverage policies and utilization and practice guidelines.
- Referred cases to the Physician Consultant, and decision-making processes were conducted to ensure that the reasons for denial were adequately detailed and concluded within the contractual deadline.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
PACU (Post Anesthesia Care Unit)
Onslow Memorial Hospital
06.2016 - 08.2019
- Proactively addressed potential postoperative complications such as nausea, vomiting, and shivering through appropriate interventions and medication administration.
- Increased continuity of care for patients transitioning from PACU to other hospital units by effectively communicating pertinent information to receiving nurses.
- Initiated immediate interventions when detecting signs of respiratory distress or airway obstruction in post-operative patients, preventing potential adverse events.
IMCU (Intermediate Care Unit)
Onslow Memorial Hospital
08.2012 - 06.2016
- Completed daily assessments and documented information in electronic medical records.
- Managed complex cases involving multiple comorbidities, requiring critical thinking skills to prioritize interventions based on individual needs assessment.
- Educated patients and families on disease processes, medical treatments, and self-care management strategies for successful recovery.
Step Down Unit
Sentara Careplex Hospital
07.2009 - 06.2012
- Demonstrated proficiency in managing multiple high-acuity patients simultaneously while maintaining high level of attention to detail and accuracy in documentation
- Promoted culture of patient safety by consistently following proper protocols for medication administration, falls prevention, and pressure ulcer management.
- Educated patients and families about medications and treatment instructions to facilitate continuum of care.
Education
Bachelor of Science - Nursing
United Doctors Medical Center
Philippines04.1988
Skills
- Nursing Documentation
- HIPAA Compliance
- Clinical judgment
- Clinical assessment
- Medical record review
- Policy compliance
- Attention to Detail
- Accurate Documentation
- Case Management
- Care Coordination
- Medical necessity
- Inpatient
Additional Information
- IMCU-Onslow Memorial Hospital, NC 09/2006-06/ 009
- Provided optimal patient care upon admission addressing biophysical, psychosocial, environmental ,self care, educational , discharge planning and significant family support.
- Med-Surgical/Telemetry- Hi-Desert Medical Center, CA 01/2004- 08/2006
- Provided patient care/education base on disease and discharge planning needs. Patient and family education on disease process.
- Med-Surgical - Beaufort Naval Hospital, SC 09/2000-10/2003
- Provided patient care/education base on disease and discharge planning needs.
- Telemetry - Craven Regional Medical Center , NC 12/1997- 08/2000
- Provided comprehensive nursing care to patient who required continuous cardiac monitoring pre and post cardiac catheterization and pacemaker.
- Charge Nurse- Central State Hospital, Georgia 08/1992- 10/1997
- Served as Nursing Supervisor for 11-7 shift. Rotated as division building coordinator.
- Med- Surgical- Cardinal Santos Medical Center- Philippines- 08/ 988- 10/1992
- Coordinated patient care. Supervised two RN's and one LPN
Certification
- North Carolina Multistate Licensed #115099
Languages
English and Filipino-Fluent
Timeline
Concurrent Review Nurse
AmeriHealth Caritas Family Of Companies
12.2022 - Current
Utilization Review Nurse
Onslow Memorial Hospital
06.2019 - 12.2022
PACU (Post Anesthesia Care Unit)
Onslow Memorial Hospital
06.2016 - 08.2019
IMCU (Intermediate Care Unit)
Onslow Memorial Hospital
08.2012 - 06.2016
Step Down Unit
Sentara Careplex Hospital
07.2009 - 06.2012
Bachelor of Science - Nursing
United Doctors Medical Center