Mariana Fragelli
Mechanicsburg,PA
Summary
Smart Utilization Review Nurse considered critical thinker and problem-solver due to dynamic patient care planning and understanding of Medicare and Non Medicare guidelines. Known for having great rapport with providers and insurance carriers. Reliable individual bringing 4.5 years of experience in Utilization Review environments. Maintains positive relationships with case managers and providers. Remains polished and calm under extreme stress. Seasoned nursing professional offering proven clinical knowledge, natural interpersonal strengths and technical abilities. Knowledgeable about EMR charting, medication administration and interdisciplinary collaboration focused on optimizing patient care, identifying medical necessity and support. Quality-focused and efficiency-driven leader. Patient-oriented Nurse with 25 years of diverse experience in direct patient care, staff supervision and department operations. Skilled at multitasking and prioritizing patient needs and daily assignments. Offering expertise in multiple specialties from IV infusion, to Trauma, Transitional Open Heart and Telemetry skills. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level part Time position. Ready to help team achieve company goals. Hands-on professional proudly offering more than 29 years of expertise in nursing field. Well-rounded, flexible and reliable.
Overview
29
29
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse
Utilization Review Department
08.2019 - Current
- Contributed to organizational success by providing expert advice on medical necessity criteria and evidence-based practices in utilization review nursing.
- Covers 5 Teams and identifies 30 most essential cases out of a 70 plus load assignment.
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Improved patient care quality by conducting thorough utilization reviews and making recommendations for optimal treatment plans.
- Promoted positive outcomes with proactive assessment of patients'' needs and development of targeted interventions to address identified barriers to recovery.
- Optimized hospital stays by monitoring admissions for appropriateness based on established clinical guidelines while considering each patient's unique circumstances.
- Assisted discharge planning efforts through prompt identification of medically stable patients who were ready for transition to alternate levels of care.
- Minimized financial risk associated with denials or payment discrepancies through diligent validation of medical necessity prior to service provision.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
Staff/Charge/Preceptor RN
Greater Baltimore Medical Center, GBMC
01.2019 - 08.2019
- On unit 34
- Collaborated with interdisciplinary team members to optimize patient outcomes through comprehensive care coordination.
- Mentored and supervised junior nurses, fostering supportive and collaborative work environment.
- Conducted ongoing assessments to monitor and adjust treatment plans, improving overall patient health outcomes.
- Managed crisis situations effectively, ensuring safety of patients and staff members at all times.
- Facilitated timely discharge planning for patients, reducing length of hospital stays and minimizing readmission rates.
- Educated patients and families on disease management strategies, promoting adherence to treatment plans and self-care routines.
- Served as primary liaison between physicians and nursing staff, maintaining clear communication channels for optimal patient care delivery.
- Contributed to higher patient satisfaction ratings by consistently providing compassionate, empathetic care to all patients regardless of background or condition severity.
- Led successful unit initiatives aimed at improving patient care delivery, such as implementation of new nursing protocols or equipment.
- Improved continuity of care across shifts through concise shift reports detailing pertinent updates on patients'' conditions and treatment plans.
- Coordinated nursing care on unit through staff assignments, assisting and rounding with physicians, monitoring patient orders, and communicating with ancillary departments.
- Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
- Conducted daily shift briefs to inform staff of changes in patient care assignments.
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Collaborated with other healthcare professionals to provide quality patient care.
- Supervised and managed daily scheduling, tasking, and administration.
- Implemented quality patient care techniques to align with safety, health, and organizational regulations.
- Cared for patients' wounds and changed dressings.
- Supervised patient admissions and discharges from hospital to home care, rehabilitative facility, or self-care.
- Worked with patients diagnosed with chronic obstructive pulmonary disease (COPD), asthma, congestive heart failure (CHF), cerebrovascular accidents (CVA), diabetes or sepsis to asses needs and determine best options for care.
Float Pool Staff Nurse
ASAP/Float Pool
01.2014 - 12.2018
- Improved patient outcomes by providing high-quality nursing care and implementing evidence-based practices.
- Reduced medication errors through meticulous charting and double-checking dosages.
- Collaborated with interdisciplinary team members for comprehensive patient assessments and treatment plans.
- Demonstrated excellent time management skills while juggling multiple priorities in fast-paced environment.
- Developed strong rapport with patients and families, fostering trust and open communication during challenging times.
- Educated patients on self-care management, empowering them to take an active role in their overall health and wellbeing.
- Exhibited strong critical thinking skills when assessing complex medical situations and determining appropriate interventions.
- Participated in regular staff meetings to share best practices, address challenges, and foster collaboration among team members.
- Coordinated discharge planning with case managers to ensure seamless transitions of care from hospital to home or other facilities.
- Managed complex wound care, utilizing advanced techniques to promote healing and prevent infection.
- Equipped patients with tools and knowledge needed for speedy and sustained recovery.
- Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
Clinical Unit Coordinator
GBMC
01.2012 - 01.2014
- On Unit 34
- Enhanced unit efficiency by maintaining up-to-date patient information and coordinating interdisciplinary care.
- Ensured staff adherence to hospital policies through timely dissemination of regulatory updates and guidelines.
- Improved patient satisfaction by addressing inquiries promptly, escalating concerns to relevant staff when necessary.
- Facilitated smooth shift transitions by preparing detailed nursing reports and ensuring complete handover of responsibilities.
- Maintained clean, safe and organized unit environment, adhering to infection control protocols for optimal patient safety.
- Expedited discharge processes by accurately documenting patient progress notes and communicating with appropriate personnel.
- Trained new Unit Coordinators on unit-specific protocols, contributing to overall team proficiency in delivering exceptional patient care experiences.
- Managed medical emergencies calmly and effectively while activating appropriate codes according to hospital policy; ensuring prompt response from specialized personnel.
- Developed strong working relationships with ancillary departments, facilitating timely completion of diagnostic tests and treatments for patients.
- Participated in quality improvement initiatives to identify opportunities for enhancing patient care processes and outcomes.
- Demonstrated adaptability and resilience by providing support during periods of high census or staff shortages, ensuring continuity of care for all patients.
- Achieved appropriate patient flow by admitting, transferring and discharging patients in computer system and notifying appropriate personnel of patient status verbally and through signage.
- Coordinated and maintained referral sources related to admissions, discharges and follow up services to sustain daily census requirements.
- Collaborated, communicated and engaged with family and support system to support client healing process.
- Prioritized safe care for patients, staff and visitors.
- Assisted with processing patient admissions, transfers and discharges.
- Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
- Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and general liability.
Clinical Care Coordinator
Health-Ways
03.2011 - 01.2012
- For the PCMH Program
- Enhanced patient care quality by developing and implementing comprehensive care plans for each individual.
- Reduced hospital readmission rates through effective discharge planning and coordination of post-acute care services.
- Facilitated timely access to appropriate healthcare services by assessing patient needs and coordinating referrals to specialists.
- Promoted patient-centered care by actively involving patients and their families in treatment decisions and goal-setting processes.
- Educated patients on disease management strategies, enabling them to make informed choices about their health and wellbeing.
- Assisted in the development of protocols for complex case management, leading to improved outcomes for high-risk patient populations.
Staff Nurse
GBMC
02.2007 - 02.2011
- On U38 and Preceptor
Wellspan Health
10.2005 - 01.2006
- IV Infusion and Chemo Therapy Clinic
Lehigh Valley Hospital
10.1997 - 07.2005
- I worked eight years on Tele/IMC units with specialization in TOHU, Transitional Open Heart unit.
LPN
Saint Joseph's Inpatient Skilled unit
03.1995 - 07.1997
- Staff and Charge RN while studying for my RN
Education
RN-BSN - Bachelors of Nursing
Western Governors University
Salt Lake City, UT01.2020
Skills
- Utilization Review Nurse
- InterQual Criteria applied to non-Medicare Clients
- Care Coordination
- Charge/Preceptor/Resource
- Tracheostomy/Colostomy/Chest Tube and Wound Care expertise
- Skilled IV Insertion
- Advanced Cardiovascular Life Support (ACLS)
- Cardiac monitors
- CPR AED
Certification
- Critical Care Modules
- ACLS
- BLS
- Chemo Certification
References
Please feel free to contact me for any References that you may need.
Artist, Amateur Carpenter, Hardscape landscaping/gardener Wallpaper designer
I am extremely artistic and undaunted in developing new skills in the creative process.
Languages
English
Full Professional
Portuguese
Professional Working
Spanish
Limited Working
Timeline
Utilization Review Nurse
Utilization Review Department
08.2019 - Current
Staff/Charge/Preceptor RN
Greater Baltimore Medical Center, GBMC
01.2019 - 08.2019
Float Pool Staff Nurse
ASAP/Float Pool
01.2014 - 12.2018
Clinical Unit Coordinator
GBMC
01.2012 - 01.2014
Clinical Care Coordinator
Health-Ways
03.2011 - 01.2012
Staff Nurse
GBMC
02.2007 - 02.2011
Wellspan Health
10.2005 - 01.2006
Lehigh Valley Hospital
10.1997 - 07.2005
LPN
Saint Joseph's Inpatient Skilled unit
03.1995 - 07.1997
RN-BSN - Bachelors of Nursing
Western Governors University
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