SISSI JACINTO, B.S.N., RN

***** ** **** ** *******, FL 33027 305-***-****) ad4pgw@r.postjobfree.com

EXPERIENCE

INPATIENT/OBSERVATION LIAISON, Jackson Health System

JANUARY 2023 - PRESENT

UTILIZATION REVIEW/CASE MANAGEMENT, University of Miami Hospital

MARCH 2021 – JANUARY 2023

Work collaboratively with a group of medical teams to establish a safe discharge and minimize patients’ length of stay in the Hospital. Communicate with different departments to escalate and expedite patients’ procedures.

Facilitate denial prevention strategies in the Medical Denial and Appeal Department, which includes identifying root causes for denials; Assess and report patients’ conditions to insurance companies for clinical review and consideration for approval/denial; Present, prepare, and submit all recommendations for denials to insurance medical directors and liaisons; Coordinate Peer-to-Peer reviews between medical directors and attending physicians.

Review medical records and ensure that patients get the appropriate level of medical care; Complete medical reviews in InterQual system; Find the balance between the fiscal needs of the hospital and the care of each patient; Monitor observation-status patients and communicate with doctors regarding the medical needs for patient class.

CLINICAL TEAM MANAGER, Centers Plan for healthy living

SEPTEMBER 2019 – MARCH 2021

Oversee the operations provided by the organization and convey administrative tasks.

Supervise a group of 10 -12 Care Managers and treatment plans created for members.

Manage employee schedules and availability based on PTO needs.

CARE MANAGER, Centers Plan for healthy living

JANUARY 2019 – SEPTEMBER 2019

Coordinate with different departments, hospitals, or doctors to identify and manage members who require additional support in their homes to improve their quality of life.

Facilitate a safe discharge and assist in expediting authorizations for outpatient needs.

REGISTERED NURSE, PRECEPTOR, AND CHARGE NURSE

Memorial Regional Hospital South, Hollywood, FL., Telemetry February 2016-December 2018

Westside Regional Medical Center, Plantation, FL., Multisystem Progressive Care Unit January 2015-January 2016

Florida Hospital South, Orlando, FL., Multisystem Progressive Care Unit February 2013-December 2014

EDUCATION

MAY 2012

BACHELOR OF SCIENCE IN NURSING (B.S.N), Nova southeastern university

DECEMBER 2009

ASSOCIATES IN ART (A.A), Miami Dade Collage

SKILLS

Language: English and Spanish

Computer: Microsoft Office, Excel, PowerPoint

Electronic Health Record (EHR) software: InterQual, Epic, Case Trakker Dynamo, Cerner

Ability to lead and motivate others

Excellent organizational, interpersonal, verbal and written communication skills

Ability to attend to detail, organize tasks/priorities and complete with accuracy

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