Paramjit P. Tijerina
Roseville,CA
Summary
Well-qualified medical professional with experience triaging patients, capturing information and completing various procedures. Excellent communication, prioritization and multitasking abilities with sound judgment and compassionate nature. Background in clinic and hospital environments within the licensed nursing and nursing student roles
Overview
21
21
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse/Care Management
Adventist Health
01.2019 - 01.2023
- Provide clinical reviews for all inpatient admission/ outpatient services requiring pre-authorization for surgical procedures
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Maintained professional competence by staying current on industry trends, best practices, and regulatory requirements specific to utilization review nursing.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Perform concurrent and retrospective medical/record/case reviewing utilizing appropriate clinical knowledge, critical thinking, clinical decision support tools and medical resources
- Liaison to patients and their families, providers, medical professionals, healthcare professionals, discharge planning teams, contracted health plans/partners and internal departments
Utilization Review/Case Management Nurse
River City Medical Group
01.2017 - 01.2019
- Ongoing assessment of all potential case management member cases and follow up with health care needs, incorporates disease management protocols, ensures continuity of care through discharge planning and utilization of resources, and shifts cost to appropriate payers
- Care coordination between providers/physicians, social workers, complex case management team as needed as well as collaborate work with Medical Director for complex cases
- Identifies cases for clinical review by evaluating appropriateness of admission, inpatient stay, surgical procedures, acute rehabilitation/SNF status, level of care, and discharge using Milliman, guidelines, InterQual review
- Conduct onsite hospital visits to assigned hospital networking with case managers for patient's discharge needs and resource management
- Collect utilization data and quality information to determine delay in service, readmissions and length of stay in hospital; appropriately documenting into EMR per shift
- Employee Ambassador for the inpatient utilization management department
Licensed Vocational Nurse/Counselor
Center for Discovery Sacramento
01.2016 - 01.2017
- Provide direct patient/client care (e.g
- Admissions, vital signs, crisis management, determine ICD codes for diagnoses for lab workup and discharge needs, care coordination)
- Document and communicate the medical and psychosocial progress of the client
- Provide primary first aid and determine needs and report findings to physician
- Facilitate and lead group therapy discussion with clients/patients
- Assist overseeing the eating disorder, dietary, health management
Licensed Vocational Nurse
Maxim Health/Home Health
01.2014 - 01.2016
- Provide direct care for patients w/ cerebral palsy, down-syndrome and epilepsy high risk conditions
- Administer medications, medical treatments, diabetic management and G-Tube care
- Collaboration of care with special needs staff such as Occupational, Speech, Physical and Vision therapist as well as Special Educators and Medical Staff
- Discuss patient findings and plan of care with RN case manager
Staff Licensed Vocational Nurse
Kaiser Permanente
06.2002 - 05.2013
- Administered medications, immunizations, medical treatments, IV therapy, NG insertions, continuous monitoring
- Performed EKG, point of care testing, and orthopedic interventions
- Provided care to patients with urgent and unpredictable needs and potential hospital admissions in Urgent Care clinic
- Initiated treatment of wound vac and care
- Assisted clinical educators in creating and implementing nursing educational aids
- Coordinated class schedules; staff communications; annual core competency trainings
- Conducted quality and safety evaluation and audits; reviewing case by case conditions of patients
- Administered flu vaccinations for the South Sacramento and Roseville sites of Kaiser members
- Maintained flow of admits/discharges/transfers
- Provided direct patient care and advocacy on medical-surgical units
- Provided emotional, physical and educational support of the patient and family centered complexities
- Collaborated with multi-interdisciplinary team to provide the most appropriate optimal acute care
Education
Nursing Student BSN Program -
William Jessup University
05.2025
Bachelor of Science in Health Care Administration & Mgt -
University of Phoenix
Associate of Science in Natural Sciences -
Sierra Community College
Roseville, CALicensed Vocational Nurse Training -
Tri-County Vocational Nursing Program
Yuba City, CASkills
- InterQual Criteria
- Documentation And Reporting
- Utilization review
- Records analysis
- Medication Administration
- Direct Patient Care
- Mental Health Support
- Aseptic Techniques
- Vital signs monitoring
- Venipuncture (IV/Phlebotomy Certified)
- Health Education
Certification
- LVN License- IV Therapy and Phlebotomy- since 2002
- BLS Health Care Providers- 2025
- Competent in: Microsoft Word and Excel, Google Docs/Drive, Email, eFax
- Experience with Epic, Cerner, UC Davis Quick Cap 7.0 and Best Notes EHR, Cognizant
Volunteer
- Group Leader, Nursing Christian Fellowship, InterVarsity Local Chapter, William Jessup University Campus, Rocklin, CA.
- Lobby Host and Greeter, Outreach/Mission Volunteer, The Rock of Roseville
- Student Nurse Volunteer, Sutter Roseville Medical Center, Summer through Fall 2023
Timeline
Utilization Review Nurse/Care Management
Adventist Health
01.2019 - 01.2023
Utilization Review/Case Management Nurse
River City Medical Group
01.2017 - 01.2019
Licensed Vocational Nurse/Counselor
Center for Discovery Sacramento
01.2016 - 01.2017
Licensed Vocational Nurse
Maxim Health/Home Health
01.2014 - 01.2016
Staff Licensed Vocational Nurse
Kaiser Permanente
06.2002 - 05.2013
Nursing Student BSN Program -
William Jessup University
Bachelor of Science in Health Care Administration & Mgt -
University of Phoenix
Associate of Science in Natural Sciences -
Sierra Community College
Licensed Vocational Nurse Training -
Tri-County Vocational Nursing Program
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