Stephanie Reyestan
Edinburg,TX
Summary
Dedicated, responsible and results-oriented professional with over 20+ years experience in clinical experience and Utilization Review Nurse. Capable of thinking and acting quickly in stressful emergency situations. Effective communication and team-building skills with interdisciplinary team with proven knowledge of utilization review and clinical experience. Detail-oriented and hard working professional with excellent communication, interpersonal and creative thinking skills. Aiming to leverage my abilities to successfully fill the vacancy at your company. Dedicated professional with proven performance in management, leadership and communication. Detail-oriented in problem-solving and planning. Ready to make an immediate contribution to your organization.
Developed valuable skills in clinical setting, ready to transition into new field. Demonstrated expertise in analyzing patient data and optimizing care plans. Seeking to leverage strong analytical and communication skills in new professional environment.
Dynamic individual with hands-on experience in NICU/Pediatrics and talent for navigating challenges. Brings strong problem-solving skills and proactive approach to new tasks. Known for adaptability, creativity, and results-oriented mindset. Committed to making meaningful contributions and advancing organizational goals.
Patient-oriented Nurse with 20+ 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 with NICUspecialty.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse
Centene Corporation
10.2018 - Current
- 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.
- Improved patient care quality by conducting thorough utilization reviews and making recommendations for optimal treatment plans.
- Contributed to organizational success by providing expert advice on medical necessity criteria and evidence-based practices in utilization review nursing.
- Fostered a culture of continuous learning by actively participating in departmental meetings, trainings, and continuing education opportunities related to utilization review.
- Minimized financial risk associated with denials or payment discrepancies through diligent validation of medical necessity prior to service provision.
- Increased staff efficiency by providing ongoing education on proper documentation techniques necessary for accurate claims processing.
- Assisted discharge planning efforts through prompt identification of medically stable patients who were ready for transition to alternate levels of care.
- Supported data-driven decision-making by regularly analyzing trends in resource utilization, identifying opportunities for improvement, and implementing best practices.
- Supported organizational growth and development through effective collaboration with interdisciplinary teams focused on improving the quality, safety, and efficiency of healthcare delivery.
- Reduced unnecessary medical costs, ensuring treatments met established medical guidelines and policies.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Participated in evidence-based practice project implementation, nursing competency development and nursing simulation activities.
Registered Nurse, NICU
Knapp Medical Center
11.2014 - 09.2018
- Maintained a safe and clean environment by adhering to infection control policies, proper equipment handling, and waste disposal procedures.
- Reduced complications by closely monitoring vital signs, administering medications, and assessing newborns'' overall condition.
- Collaborated with multidisciplinary healthcare teams to develop individualized plans of care for premature and critically ill neonates.
- Provided compassionate end-of-life care for terminally ill neonates while offering emotional support to grieving families.
- Facilitated effective communication between families, physicians, therapists, social workers, dietitians, pharmacists – fostering a collaborative approach to holistic neonatal healthcare delivery.
- Enhanced patient care by implementing evidence-based nursing practices and protocols in the NICU setting.
- Assessed, evaluated, and cared for neonate and pediatric patients.
- Optimized medication administration safety through careful double-checking of dosages and adherence to proper storage guidelines.
- Promoted family-centered care by providing education, support, and resources to parents of NICU patients.
- Advocated for patient rights and needs, ensuring a patient-centered approach to care delivery within the NICU setting.
Registered Nurse, NICU
Memorial Hermann Hospital System
10.2011 - 10.2014
- Managed patients with oxygen therapy including high frequency oscillatory ventilation (HFOV), inhaled nitric oxide (iNO), noninvansive mechanical ventilation (NIMV), biplastic positive airway pressure (BiPAP), continuous positive airway pressure (CPAP), and high flow nasal cannula
- Administered care of patients with gastroschisis/omphalocele
- Activities performed include caring for neonates with congenital heart defects, meconium aspiration, extremely low birthweight, congenital anomalies, sepsis/pneumonia, feeding intolerances, withdrawal, hypoglycemia and hyperbilirubinemia
- Managed neonates with cardiac monitoring, pulse oximetry, isolettes, IV medication adminisration, IV infusions, PICC, arterial, Broviac and UAC/UVC lines, nasogastric/orogastric tubes
Registered Nurse, NICU
Doctors Hospital at Renaissance Health System
02.2008 - 09.2011
- Facilitated smooth transitions between hospital departments by ensuring proper handoff communication regarding patients'' ongoing infusion needs during transfers.
- Maintained detailed documentation of all aspects of IV therapy administration, including assessments, interventions, and patient responses, ensuring accurate record keeping for optimal continuity of care.
- Served as a reliable resource for patients and families, providing support and guidance throughout the course of intravenous therapies.
- Supported efficient patient care by promptly responding to physician orders for IV therapies and coordinating with pharmacy staff as necessary.
- Reduced risk of infection by maintaining sterile environments while inserting, replacing, or removing IV lines.
- Contributed to a positive work environment by mentoring new nursing staff on best practices in IV therapy administration.
- Exemplified a strong commitment to patient privacy by maintaining confidentiality of medical records and personal information in accordance with HIPAA regulations.
- Enhanced nursing skills through ongoing professional development in the field of infusion therapy, staying current with advancements in techniques and technologies.
- Promoted patient safety through strict adherence to infection control protocols during all aspects of IV insertion and maintenance.
- Enhanced patient comfort by administering IV medications and fluids with precision and care.
- Assisted physicians with bedside procedures such as central line insertions or PICC line placements, ensuring patient safety and comfort throughout.
- Increased patient satisfaction by providing thorough education on IV procedures and addressing any concerns or questions promptly.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
- Educated family members and caregivers on patient care instructions.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
- Monitored patient reactions after administering medications and IV therapies.
- Provided skilled, timely and level-headed emergency response to critically-ill patients.
- Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
- Observed and documented patient factors such as diets, physical activity levels, and behaviors to understand conditions and effectively modify treatment plans.
Registered Nurse, NICU
Rio Grande Regional Hospital
11.2004 - 11.2008
- Guided patients, caregivers, and family members on plans of treatment and helpful resources available locally to support care.
- Evaluated patient histories, complaints, and current symptoms.
- Administered medications and treatments as ordered by physician.
- Conducted patient assessments, recorded vitals, and analyzed records and charts to define care requirements.
- Led quality improvement projects focusing on patient safety, resulting in reduction of medication errors.
- Enhanced patient recovery by providing specialized care for premature and critically ill newborns in high-stress NICU environment.
- Reduced incidence of hospital-acquired infections, adhering strictly to infection control protocols.
- Enhanced patient care by staying abreast of latest neonatal nursing research and integrating new findings into practice.
- Collaborated with multidisciplinary teams to ensure comprehensive care for neonates, resulting in holistic health improvements.
- Conducted detailed assessments of neonatal patients to identify care needs and monitor progress.
- Maintained meticulous records of patient care, treatment plans, and progress notes, ensuring accuracy and compliance with healthcare regulations.
- Improved NICU's operational efficiency, organizing supplies and equipment to ensure availability and readiness.
- Enhanced emotional support to parents and families, providing guidance and information throughout their NICU journey.
Education
Associate in Science (A.S.) - Nursing
South Texas College
Mcallen, TX05.2003
Skills
- Flexible Schedule
- Utilization Review
- Documentation skills
- HIPAA compliance
- Discharge planning
- Computer skills
- Organizational skills
- Management skills
- Interpersonal skills
- Neonatal medical terminology
- Clinical experience
- ICD coding
- CPT coding
- Medicaid reviews
- Ambetter reviews
- Analytical skills
- Decision making skills
- InterQual criteria
- Documentation and reporting
- Utilization review
- Records analysis
- Interpersonal and written communication
- Clinical assessment
- Discharge planning coordination
- Insurance verification
- Quality improvement
- Inpatient care
- Healthcare regulations
- Medicaid
- Performing assessments
- Compliance procedures
- Communication
- Patient care assessment
- Specialized healthcare referrals
- Blood draw and sample collection
- Teamwork and collaboration
- Problem-solving
- Medication and IV administration
- Time management
- Attention to detail
- Problem-solving abilities
- Multitasking
- Compassionate and caring
- Multitasking Abilities
- Basic life support
- Reliability
- Excellent communication
- Critical thinking
- Strong clinical judgment
- Direct patient care
- CPR certification
- Active listening
- Effective communication
- Adaptability and flexibility
- Creative problem solving
- Decision-making
- Team collaboration
- Patient and family advocacy
- Monitoring vital signs
- Physical assessment
- Vitals monitoring
- Relationship building
- Clinical documentation
- Electronic health records
- Clear patient communication
- Pain management
- Critical care nursing
- Intravenous therapy
- Team building
- Task prioritization
- Self motivation
- Infection control
- Patient condition monitoring
- Analytical thinking
- Care coordination
- Documentation
- Goal setting
- Accurate documentation
- CPR/AED
- Health promotion
Certification
- Registered Nurse License (RN) - State Board of Nursing.
- Basic Life Support Certification (BLS)
- CPR/AED Certification
Languages
English
Full Professional
Timeline
Utilization Review Nurse
Centene Corporation
10.2018 - Current
Registered Nurse, NICU
Knapp Medical Center
11.2014 - 09.2018
Registered Nurse, NICU
Memorial Hermann Hospital System
10.2011 - 10.2014
Registered Nurse, NICU
Doctors Hospital at Renaissance Health System
02.2008 - 09.2011
Registered Nurse, NICU
Rio Grande Regional Hospital
11.2004 - 11.2008
Associate in Science (A.S.) - Nursing
South Texas College
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