VERONICA MAGANA
Hemet,Ca
Summary
Hands-on professional proudly offering more than 15 years of experience in healthcare environments. Well-rounded and personable Utilization Review Nurse talented in reporting, records oversight and performance improvement. Knowledgeable in admissions and stay reviews.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Inpatient Case Manager
Regal Medical Group
05.2017 - Current
- Improved patient outcomes by developing comprehensive care plans and coordinating with multidisciplinary teams.
- 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.
- Performed prior authorization review of services requiring notification.
- Improved patient care quality by conducting thorough utilization reviews and making recommendations for optimal treatment plans.
- Conducted regular audits of case files for quality assurance purposes, identifying areas for improvement and implementing corrective actions as needed.
- Maintained accurate documentation of all case management activities, ensuring compliance with regulatory standards.
- Served as a liaison between patients, families, medical staff, and external agencies to facilitate effective communication throughout the continuum of care.
Per Diem Discharge Planner
Citrus Valley Health Partners
01.2016 - 01.2018
- Improved patient satisfaction by carefully evaluating their needs and developing personalized discharge plans.
- Advocated for patients'' best interests, working closely with healthcare providers to develop appropriate treatment plans and interventions.
- Coordinated timely discharges by effectively communicating with physicians, nurses, social workers, and other relevant stakeholders.
- Solved problems related to abrupt changes in discharge, coordinated updates and communicated discharge plans.
- Established strong relationships with community agencies, enabling effective coordination of post-discharge support services.
- Streamlined the discharge process, reducing wait times and increasing overall efficiency within the hospital.
- Facilitated smooth transfers between hospital departments, minimizing delays in patient care during transition periods.
Complex Case Manager
Care1st Health Plan
06.2016 - 04.2017
- Care management, Assessments, Develop Care plan
- Provide Education on disease and medication management
- Transition of care
- Participate in ICT, Audits, compliance, and inpatient rounds as needed.
- Provided ongoing education and support to patients and their families regarding.
- Identified gaps in care or services for high-risk patients, initiating interventions to address needs proactively.
- Medical conditions, treatment options, and available resources.
- Participated in interdisciplinary team meetings focused on evaluating patient.
- Evaluated the effectiveness of case management interventions by tracking metrics related to patient outcomes, cost savings, and quality of care improvements.
Emergency Room Cardiac Monitor Technician
Queen Of The Valley Hospital
04.2015 - 05.2016
- Monitored patients' heart rhythms and functions through cardiac monitoring strips.
- Collaborated with healthcare team to maintain quality patient care.
- Served as a dependable resource for nurses and other healthcare staff, providing guidance on proper lead placement and interpretation of cardiac monitor findings.
- Trained and supervised new cardiac monitor technicians on best practices and safety measures.
- Assisted in reducing wait times by promptly answering phone calls, directing inquiries, and routing messages to appropriate personnel.
- Increased ER efficiency with prompt communication between medical professionals regarding patient updates.
- Ensured HIPAA compliance while handling sensitive patient information with utmost confidentiality and discretion.
- Streamlined workflows for nurses and doctors by accurately maintaining patient charts and updating information as needed.
Education
Associate of Science - Nursing
United University of Nursing
Murrieta, CA12.2024
Associate of Applied Science - Vocational Nursing
West Coast Ultrasound Institute
Ontario, CA10.2015
Skills
- Case Evaluation
- Quality Improvement
- HIPAA Compliance
- Clinical Documentation
- Title 22
- Healthcare regulations
- Medical Necessity Evaluation
- Utilization Review Experience
- Document Review and Approval
- Claims review
- Utilization Management
- Clinical assessment
- Medication Management
- Discharge Planning
Certification
- California LVN Licensure
- Intravenous therapy and Blood withdrawal certified
- BLS
References
Available upon request
Timeline
Inpatient Case Manager
Regal Medical Group
05.2017 - Current
Complex Case Manager
Care1st Health Plan
06.2016 - 04.2017
Per Diem Discharge Planner
Citrus Valley Health Partners
01.2016 - 01.2018
Emergency Room Cardiac Monitor Technician
Queen Of The Valley Hospital
04.2015 - 05.2016
Associate of Science - Nursing
United University of Nursing
Associate of Applied Science - Vocational Nursing
West Coast Ultrasound Institute
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