Dorie Loo

951-***-****

acgugx@r.postjobfree.com

**** ******* ***

Riverside Ca, 92506

Objectives

To obtain a position where my experience as an acute care nurse case manager, skilled nursing supervisor, utilization

review nurse, case management supervisor and Quality nurse, my ability to adapt in all areas quickly, a team player,

problem solver, my ability to work in high stress with passion and dedication will be an asset to your company.

Epic Case Manager, Utilization Review, Skilled Nursing Case Manager

Redlands Ca, Start Date last day of employment 11/25/2014

The evaluation of medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and

facility regulations under the provisions of the patient(s) healthcare benefits. To deliver direct services to patient(s)

and their families by using resources available and working directly with the patients doctor(s) to safely discharge the

patient to a lower level of care. Chart concurrent review, validate the appropriateness of proposed medical treatment,

pre-authorization if necessity of treatment, appeals, nomc’s and denc, letters.

Care 1st Case Manager, Float Case Manager, Complex Case Manager, Disease Management

Monterey Park Ca, 05/2009 to 05/2013

The evaluation of medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and

facilities under the provisions of the patient(s) healthcare benefits, float case manager, complex case management for

patients with complex chronic disease(s) assistance with needed services to help prevent re-admissions and assist with

preventive measures to help slow advancement of the patients disease(s), Disease management educational resources

to assist and educate a patient with their disease process and educate the patient with needed resources to assist with

care.

Vantage IPA, Float Case Manager, Quality Nurse, Pre-Auths Nurse, Retro Review Nurse

Riverside Ca, 03/2008 to 05/2009

The evaluation of medical necessity, appropriateness and efficiency of the use of healthcare systems and medical

administration procedures and facility regulations under the provisions of the patient(s) healthcare benefits, a daily

routine working knowledge of guidelines and regulations related to the patients insurance benefits applying these

components as needed. Ambulatory and telephonic case management, for acute and snf patients. Quality Case

Management audits, member grievances and responses, denials, appeals and yearly required employee education and

training, policy reviewing and writing/updating based off NCQA and ICE regulations. Pre-authorizations nurse

reviewed for needed medical services, reviewing services appropriate medical necessity based off MCG regulations

and/or sending to a physician to review based off the requested services.

Parkview Hospital Case Manager, Float Nurse, Er, ICU, Med Surg and Tele

Riverside Ca, 01/2006 to 03/2008

The evaluation of medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and

facilities under the provisions of the patient(s) healthcare benefits case management validate the appropriateness of

proposed medical treatment and continued necessity for continued stay as per mcg regulations, pre-authorization

review if necessity for treatment. Float nurse, Bedside care in Er, Icu, med sug and tele, med pass, wound care, patient

care, charting, care plans, Lvn supervisor, chart audits, time cards, teaching nursing skills to new nurses, disciplinary

actions as needed.

Pleasant Care Snf: Charge Nurse

Riverside Ca, 03/2005 to 01/2006

Charge nurse for all Cna’s duties/cares, assessments, clinical duties charting, audits, telephonic orders, monitoring

labs, educational teaching and training of new nurses. Med pass, wound care and discipline

Education:

A/A Platt College 1996

California Southern Law School 2000/2002 working toward JD

Paralegal 1995

Lvn Summit College 2005

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