Quinones Evelyn
Homestead,Florida
Summary
Reliable individual bringing 20 years of experience in healthcare environments. Maintains positive relationships with case managers and providers. Remains polished and calm under extreme stress.
Overview
27
27
years of professional experience
Work History
Utilization Review Registered Nurse
Homestead Hospital
10.2019 - Current
- Enhanced efficiency of utilization review process by collaborating with interdisciplinary teams and streamlining communication channels.
- Served as a liaison between healthcare providers, insurance companies, and patients for efficient resolution of coverage issues or denials following a utilization review assessment.
- Promoted interdepartmental collaboration to streamline workflow processes, resulting in improved efficiency and patient outcomes.
- Reduced hospital readmissions with proactive identification of high-risk patients and implementation of targeted interventions.
- Provided accurate documentation of all utilization review findings, ensuring a clear audit trail for future reference or analysis.
- Expedited discharge planning processes through timely completion of utilization reviews that identified necessary services, supports, or referrals post discharge.
- Established strong working relationships with insurance representatives, fostering open communication channels for efficient resolution of coverage issues or disputes related to medical necessity determinations.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Supervised and maintained all utilization review documentation through InterQual or Milliman.
RN Case Manager
Homestead Hospital
03.2015 - 09.2019
- Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
- Educated patients and families on available community resources, facilitating access to necessary support services.
- Served as a key liaison between patients, families, and healthcare providers, fostering open communication and trust among all parties involved in the care process.
- Coordinated care conferences with interdisciplinary team members, ensuring all perspectives were considered in the development of comprehensive treatment plans.
- Optimized resource utilization by identifying opportunities for cost containment while maintaining quality of care.
- Mentored new nursing staff, facilitating a faster learning curve and increased overall team efficiency.
Surgical Technology Clinical Coordinator
Homestead Hospital
02.2011 - 03.2015
- Verified insurance coverage and obtained pre-authorizations.
- Resolved scheduling conflicts to maintain high-quality patient services.
- Expertly managed planning, scheduling, and coordination of outpatient procedures.
Registered Nurse, Endoscopy
Homestead Hospital
03.2006 - 04.2011
- Assisted physicians in performing complex endoscopic procedures, ensuring patient safety and comfort throughout.
- Applied advanced nursing skills to handle emergency situations during endoscopic procedures calmly and effectively.
- Managed sedation administration for optimal pain relief during clinical sessions while monitoring vital signs closely.
RN House Supervisor Intern
Homestead Hospital
04.2005 - 01.2006
- Enhanced patient satisfaction through effective communication, empathy, and timely response to their needs.
- Mentored new nursing staff, contributing to a supportive work environment and improved retention rates.
- Organized and managed care of patients undergoing various therapies and procedures.
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
- Collaborated with interdisciplinary teams for comprehensive patient care plans, resulting in better health outcomes.
- Bed Placement Coordinator, delegating PCS to accept admitted patients in a timely manner.
Emergency Room Registered Nurse
Palm Springs General Hospital
03.2002 - 11.2004
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Assisted physicians during invasive procedures such as central line insertions or intubations, ensuring safe and accurate completion of tasks.
- Provided emotional support to patients and families during crisis situations, helping them cope more effectively with difficult circumstances.
RN, Emergency Room
Hospital San Carlos Borromeo
09.1997 - 02.2002
- Effectively managed multiple complex cases simultaneously while maintaining the highest level of quality care possible.
- Increased patient safety by promptly identifying and addressing potential risks or complications during their stay in the emergency room.
- Teamed on trauma and emergency interventions involving serious head injuries, gunshot wounds, and thoracic trauma.
- Promoted an inclusive healthcare environment that respected diverse cultural backgrounds and values.
Education
Bachelor of Science - Nursing Education
Universidad Interamericana De Puerto Rico
Aguadilla, PR05.1997
Skills
- Quality Improvement
- Utilization review
- Strong Clinical Judgment
- Microsoft Office
- Training staff
- Case Management
- Resource Utilization
- Discharge planning coordination
Additional Information
Participated In Magnet Ambassador Committee
Escort Magnet Recognition Visit Site
UPC Leader Magnet Recognition
Community Health Fair Volunteer
Preceptor
Languages
English
Spanish
Timeline
Utilization Review Registered Nurse
Homestead Hospital
10.2019 - Current
RN Case Manager
Homestead Hospital
03.2015 - 09.2019
Surgical Technology Clinical Coordinator
Homestead Hospital
02.2011 - 03.2015
Registered Nurse, Endoscopy
Homestead Hospital
03.2006 - 04.2011
RN House Supervisor Intern
Homestead Hospital
04.2005 - 01.2006
Emergency Room Registered Nurse
Palm Springs General Hospital
03.2002 - 11.2004
RN, Emergency Room
Hospital San Carlos Borromeo
09.1997 - 02.2002
Bachelor of Science - Nursing Education
Universidad Interamericana De Puerto Rico
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