MARICELA DANIELS
Greensboro
Summary
Experienced Reconsideration Nurse at Optum with expertise in utilization review and case management. Proven ability to analyze complex medical records and collaborate effectively with interdisciplinary teams. Skilled in maintaining compliance and precise documentation while providing patient education and support. Committed to enhancing care quality and ensuring timely service delivery.
Overview
13
13
years of professional experience
Work History
Reconsideration Nurse
Optum
02.2025 - Current
- Reviewed denied authorization requests and performed second-level clinical evaluations to assess reconsideration necessity.
- Analyze medical records, provider documentation, and evidence-based criteria to support appeal decisions.
- Collaborated with Medical Directors to clarify complex clinical scenarios, ensuring accurate and fair determinations.
- Ensured compliance of all reconsideration reviews with regulatory, contractual, and internal quality standards.
- Maintain detailed, compliant documentation of all review activities within UM systems.
Utilization Management Specialist
Optum
10.2022 - Current
- Conduct initial and concurrent reviews using InterQual criteria to determine medical necessity.
- Collaborate with facility clinicians and Medical Directors to evaluate plans of care and ensure appropriate levels of service.
- Identified delays in care and coordinated with providers to resolve barriers, ensuring timely patient access to necessary services.
- Facilitated timely discharge planning and transitions to alternate levels of care, enhancing continuity of patient care.
- Maintain compliance with federal, state, and accreditation standards.
- Participated in audits, team meetings, and process-improvement initiatives to strengthen compliance and operational efficiency.
Agency Registered Nurse
IntelyCare
01.2021 - Current
- Deliver high-quality nursing care across diverse facilities, adapting quickly to varying patient populations.
- Perform wound care, injections, IV therapy, and emergency interventions.
- Monitored patient progress and medication effects to ensure optimal treatment responses.
- Collaborated with interdisciplinary teams to maintain continuity of care and enhance patient outcomes.
- Educated families on care plans and provided updates to facilitate smooth discharge processes.
- Document assessments, treatments, and care plans accurately in EMR systems.
Hospice RN
Durham VA Medical Center
06.2018 - 01.2021
- Delivered compassionate end-of-life care to adult and geriatric Veterans, enhancing their quality of life during critical moments.
- Educated and supported families throughout hospice journey, empowering them to make informed decisions for their loved ones.
- Completed comprehensive assessments and ensured accurate documentation.
- Assessed medical guidelines and benefit coverage to ensure appropriate services, facilitating access to necessary care for patients.
- Coordinated staff assignments and managed unit workflow.
Admissions RN
Transitions LifeCare
04.2017 - 03.2018
- Coordinated care with physicians, social workers, therapists, and nursing staff to ensure comprehensive patient support.
- Provided education to patients and caregivers on hospice services and palliative procedures, enhancing understanding of care options.
- Conducted start-of-care assessments, developing individualized hospice plans to address patient needs.
Registered Nurse
Great Lakes Caring Hospice
07.2016 - 04.2017
- Admitted patients to hospice services, conducting ongoing assessments to tailor care plans.
- Communicated significant changes in patient conditions to physicians and supervisors for timely interventions.
- Ensured safe environments by promptly reporting concerns and implementing corrective measures.
Registered Nurse – After Hours
Seasons Hospice
07.2015 - 07.2016
- Delivered urgent after-hours hospice care, managed symptoms, and provided crisis support to enhance patient comfort.
- Facilitated patient deaths, offered emotional support to families, and coordinated with mortuaries and vendors to ensure seamless transitions.
- Documented assessments and updated care plans across multiple platforms to maintain continuity of care.
RN Case Manager
Hospice Advantage
04.2015 - 07.2015
- Managed patient caseloads and coordinated interdisciplinary care to prevent unnecessary hospitalizations.
- Coordinated patient care plans with interdisciplinary teams for optimal outcomes.
- Assessed patient needs through comprehensive evaluations and personal interviews.
- Educated families on disease processes and symptom control to enhance patient self-management and improve wound care outcomes.
- Developed educational materials for families on hospice services and end-of-life care.
RN Case Manager
Heartland Hospice
12.2014 - 04.2015
- Managed 15+ patients, developed individualized care plans, and supervised CNA/LPN staff to ensure quality of care.
- Managed hospice services to ensure quality care delivery.
- Coordinated patient care plans with interdisciplinary teams.
- Participated in interdisciplinary meetings to coordinate care and provided compassionate end-of-life support to patients and families.
- Assessed patient needs and developed effective support strategies.
Registered Nurse
Whitehall of Deerfield
02.2014 - 02.2015
- Charge Nurse for a 50-resident long-term care unit.
- Coordinated admissions, IV/PICC care, wound care, and interdisciplinary collaboration to ensure comprehensive patient management.
- Supervised night shifts and optimized staff schedules to maintain operational efficiency in a long-term care unit.
Registered Nurse
Hospitality Nursing & Rehab
09.2013 - 02.2014
- Administered medications and monitored patient responses during home visits.
- Administered medications and performed treatments while documenting patient care to ensure accurate records.
- Collaborated with interdisciplinary team to develop personalized care plans.
- Participated in care planning and interdisciplinary conferences to contribute to comprehensive patient treatment strategies.
- Provided compassionate end-of-life care to patients in hospice settings.
Registered Nurse
Linden Grove
01.2013 - 12.2013
- Managed emergency responses and administered medications via multiple routes, ensuring patient safety and well-being.
- Administered medications and monitored patient responses.
- Delivered compassionate nursing care to residents with Alzheimer’s and dementia, enhancing their quality of life.
- Provided compassionate patient care in hospice settings.
- Collaborated with interdisciplinary teams for care planning.
Education
Associate Degree - Nursing
Bryant & Stratton College
Milwaukee, WI08-2013
Skills
- Utilization/reconsideration review
- InterQual and MCG guidelines
- Case management and care coordination
- Patient assessment and admission
- Discharge planning and continuity of care
- Medication administration and monitoring
- Maintain precise documentation
- Emergency response and crisis management
- Hospice and palliative care
- Team leadership and staff training
- HIPAA compliance and critical thinking
- Problem solving and patient education
- Family education and communication
Licenses
- North Carolina, RN (Multistate), #299663
- New York, RN, #041418072
Timeline
Reconsideration Nurse
Optum
02.2025 - Current
Utilization Management Specialist
Optum
10.2022 - Current
Agency Registered Nurse
IntelyCare
01.2021 - Current
Hospice RN
Durham VA Medical Center
06.2018 - 01.2021
Admissions RN
Transitions LifeCare
04.2017 - 03.2018
Registered Nurse
Great Lakes Caring Hospice
07.2016 - 04.2017
Registered Nurse – After Hours
Seasons Hospice
07.2015 - 07.2016
RN Case Manager
Hospice Advantage
04.2015 - 07.2015
RN Case Manager
Heartland Hospice
12.2014 - 04.2015
Registered Nurse
Whitehall of Deerfield
02.2014 - 02.2015
Registered Nurse
Hospitality Nursing & Rehab
09.2013 - 02.2014
Registered Nurse
Linden Grove
01.2013 - 12.2013
Associate Degree - Nursing
Bryant & Stratton College