Experience

Regal Heights Rehabilitation and Health Care Center

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Charge Nurse

  • Feb 2022 - Present

  New York, New York, United States ▪ Responsible for the operation of the nursing unit (Subacute, Rehabilitation, Dementia/Behavioral, Long-term Care) which includes planning, coordinating, and evaluating nursing unit activities. ▪ Identifies the procedures, processes, and patient care to be accomplished during the work period, as well as the resources that will be required to safely carry out the work of the unit. ▪ Provides ongoing coordination of work and resources as necessary to meet changing requirements in the… Show more ▪ Responsible for the operation of the nursing unit (Subacute, Rehabilitation, Dementia/Behavioral, Long-term Care) which includes planning, coordinating, and evaluating nursing unit activities. ▪ Identifies the procedures, processes, and patient care to be accomplished during the work period, as well as the resources that will be required to safely carry out the work of the unit. ▪ Provides ongoing coordination of work and resources as necessary to meet changing requirements in the work environment. ▪ Evaluates individual and collective outcomes of the patient care provided during shift, compares patient care delivery to accepted standards, adjusts assignment of resources as necessary, and reports changing needs and outcomes to the healthcare staff. Show less



Shearwater Health

• Hospitals and Health Care
• 500 - 600 Employee

• Clinical Quality Assurance Specialist

  • Jul 2015 - Jan 2022

  National Capital Region, Philippines ▪ Performs quality audits for completed/closed cases for Requests for Authorization from providers by Utilization Review Nurses, Intake and Claims Assistants and validates results and communicates recommendation to Operations and QA Management. ▪ Participates in designs, review, and amendment of QA monitoring tools and guides. ▪ Keeps track of quality monitoring data management systems and documents the Nurses’ performance. ▪ Monitors client grievances and client reported… Show more ▪ Performs quality audits for completed/closed cases for Requests for Authorization from providers by Utilization Review Nurses, Intake and Claims Assistants and validates results and communicates recommendation to Operations and QA Management. ▪ Participates in designs, review, and amendment of QA monitoring tools and guides. ▪ Keeps track of quality monitoring data management systems and documents the Nurses’ performance. ▪ Monitors client grievances and client reported errors and performs Root Cause Analysis to determine the underlying cause and to formulate Action Plans and solutions. ▪ Participates in customer and client programs and meetings to report on weekly/monthly account performance and identifies client needs and expectations. ▪ Coordinates QA internal and external QA calibration sessions to streamline and reinforce best practices and correct workflow.

• Utilization Review Nurse– CA Workers’ Compensation

  • Jan 2013 - Jul 2015

  National Capital Region, Philippines ▪ Responsible for reviewing proposed hospitalization, home care, and inpatient/outpatient treatment plans for medical necessity and efficiency by applying appropriate medical criteria to first level reviews and utilizing state or state recommended guidelines (if available). ▪ Refers to a review physician when the treatment request does not meet necessity per guidelines, when guidelines are not available, or per customer account instructions. Referrals must be made in a timely manner… Show more ▪ Responsible for reviewing proposed hospitalization, home care, and inpatient/outpatient treatment plans for medical necessity and efficiency by applying appropriate medical criteria to first level reviews and utilizing state or state recommended guidelines (if available). ▪ Refers to a review physician when the treatment request does not meet necessity per guidelines, when guidelines are not available, or per customer account instructions. Referrals must be made in a timely manner, allowing the review physician time to make appropriate contact with the requesting provider in accordance with departmental policy and within state or URAC mandated turnaround times. ▪ Reviews, documents, and communicates all utilization review activities and outcomes including, but not limited to, all calls made and received in regard to case communication and all demographic and service group information. Sends appropriate system-generated letters to providers, facilities, claim payers, claimants, and claimants’ attorneys.