Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Awards
Languages
Timeline
Generic

Paul Ramos

Nashville

Summary

Dedicated and compassionate Pediatric Oncology Nurse with13 years of experience in utilization management and a strong clinical background in pediatric oncology care. Proven expertise in coordinating and overseeing treatment plans, ensuring quality patient care, and managing complex cases in both inpatient and outpatient facility settings. Adept at working collaboratively with multidisciplinary teams to deliver individualized care, optimize treatment outcomes, and advocate for patients' need. With a deep understanding of healthcare regulations, insurance protocols, and evidence-based practices, I bring a unique combination of clinical nursing expertise and utilization management experience to improve patient care. Passionate about delivering high-quality, patient-centered care and supporting families through challenging treatments and recovery.

Overview

16
16
years of professional experience
1
1
Certification

Work History

Worker’s Compensation Professional – Utilization Review Nurse

Shearwater Health
01.2015 - Current
  • Responsible for reviewing medical records, assessing treatment plans, and determining the medical necessity and appropriateness of treatments provided to injured workers under workers' compensation claims
  • Work closely with healthcare providers, claims adjusters, and case managers to ensure that medical services are consistent with established clinical guidelines and applicable regulations
  • Achieve operational objectives by contributing information and recommendation to strategic plans and reviews; preparing and completing action plans; implementing production, productivity, quality and customer-service standards; resolving problems; identifying trends; determining system improvements; and implementing change

Utilization Management Nurse for Aetna

EXL
01.2012 - 01.2015
  • Review precertification request for medical necessity, referring for Medical Director those that require additional expertise; Ensure patient will receive appropriate service at the right time and for the right duration of time

Pediatric Hematology/Oncology Nurse I

Philippine Children’s Medical Center
01.2009 - 01.2012
  • Give direct, individualized patient care utilizing the Nursing Process among pediatric cancer patient
  • Work closely with multidisciplinary teams delivering individualized care, monitor treatment progress, and provide education and emotional support to patients and families in a hospital setting

Education

Master’s - Business Administration

University of The Philippines
06.2018

Bachelor of Science - Nursing

University of Perpetual Help DALTA
05.2008

Skills

  • Clinical assessment
  • Patient care plans
  • Inpatient care
  • Compassionate and caring
  • Documentation and reporting
  • Utilization review

Accomplishments

  • Patient Care - Delivered compassionate care that exceeded hospital requirements. Successfully provided quality care to patients in an inpatient and outpatient environment.
  • Charting - Developed and organized 300+ charts for all new and current patients, routinely updating information for physician reference.
  • Clinical Skills - Monitored patients' respiration activity, blood pressure and blood glucose levels in response to medical administration.
  • Patient Advocacy - Explained treatment procedures, medication risks, special diets and physician instructions to patients.

Certification

  • Registered Nurse, January2010
  • Tennessee (compact state)
  • Illinois (single state)
  • New Jersey (single state)

Awards

Shearwater Health CEO’s Annual Award, December2018, Peer Reviewed Academic Research, Australasian Marketing Journal, May2018, Shearwater Health Country Manager’s Award for Exemplary Performance, December2015, Cum Laude, May2008

Languages

English
Full Professional

Timeline

Worker’s Compensation Professional – Utilization Review Nurse

Shearwater Health
01.2015 - Current

Utilization Management Nurse for Aetna

EXL
01.2012 - 01.2015

Pediatric Hematology/Oncology Nurse I

Philippine Children’s Medical Center
01.2009 - 01.2012

Master’s - Business Administration

University of The Philippines

Bachelor of Science - Nursing

University of Perpetual Help DALTA
Paul Ramos