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Utilization Management RN, Concurrent Review, RN Case Manager

Location:
Oceanside, CA
Posted:
August 03, 2021

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Resume:

A U T U M N O S O R I O

858-***-****

adn0wo@r.postjobfree.com

**** ******** **.,

Oceanside, CA 92054

PROFESSIONAL SUMMARY

I am Offering the knowledge and abilities necessary with a diverse set of skills honed over my 13 years in the medical field and 25 years in the workforce to deliver exceptional value to you, your customers and your companies mission. Highly experienced and well-trained nursing / business professional with sound clinical

/ business knowledge and judgment.

Couple my life experience with business leadership experience, ranging from Real Estate, Student Loan Corporation, as well as starting my own company with its line of fishing apparel.

SKILLS

Expertly build patient and medical

team.

Strategic communications with key

customer decision makers satisfaction.

Patient and family education; ensure

patients and family are educated in

projected outcomes and goals.

Detail oriented

Strong Critical Thinking Skills Extensive Group Management experience, including staffing,

evaluations, budgeting, and care

management planning.

Addressing the care of patients with

acute, real-time needs and tailors

interventions to fill the needs of the

patient for the most optimal outcome.

Clear and convincing client / customer

service skills; maintains logic and clarity

in pressure situations.

Conducts quality assurance audits to

maintain a positive and fiscally stable

workflow.

Maintaining policy and procedures

protecting patients HIPPA rights.

Exceptional interpersonal and

communication skills with proficiency

to promote confidence while building

and maintaining trust of client and

colleague relationships, while

interfacing positively with people of

diverse backgrounds.

Managed healthcare programs - HMO,

PPO, and POS.

Utilization Management Guidelines Computer Skills and Experience AO

Highly proficient in Microsoft Word,

Health Connect, Senior Matrix,

InterQual,Cerner, Excell, Microsoft

Office Suite, ICD-9 and CPT 4 coding

Strong ability and desire to quickly learn

any new computer program at any

time.

EXPERIENCE

Registered Nurse Case Manager / Utilization Review / Discharge Planning, Kaiser Permanente, Mar 2015 - Current, San Diego, CA

ER/Admitted Patients Assesses patient needs and appropriateness of the admission as well as InterQual to effectively assess qualifying stay. Define the role of the patient needs and match to the facilities ability to provide those needs effectively.

Directly responsible for understanding the patient's diagnosis utilizing my Registered Nurse License to its fullest extent.

Using critical thinking to ensure the patient is getting the services needed, equipment needed as well as eliminating what is not needed to save money for the organization and patient.

Identify any problems or issues that might interfere with the provision of cost effective, quality care.

Identified deviations and wellness changes and made recommendations, adjustments, and reports.

Educate patients and families on conditions, treatments, and possible outcomes. Comply with HIPAA guidelines in all areas of work. Combine administrative leadership and clinical expertise to shape internal nursing policies and programs.

Audit admissions and re-admissions for appropriate transcription of medical orders to verify correct application of care plans.

Consult on proposed discharge plans, coordinating procedures with appropriate medical, nursing, and transportation personnel.

Registered Nurse Consultant Health Care Solutions, Force O Six, Jan 2018 - Jan 2020, San Diego, CA

Served as a Project Case Manager and trainer of Healthcare Solutions team. Collaborated with CEO and investors.

Held weekly meetings with interdepartmental representatives to coordinate multi- discipline efforts and initiatives.

Led the team as they implemented their web based case management protocol. Monitored case management reports. Responsible for Quality Control. Addressed education opportunities for staff and clinicians as necessary; especially in response to trends and audits. Monitored and disseminated regulatory changes impacting the revenue cycle, set and enforced policies, procedures and guidelines, ensuring timely and accurate operations.

Utilized healthcare information technology to improve quality, safety and cost effectiveness of care. Followed policies, upheld professional standards. Nov 2008

Post-Anesthesia Care Unit Registered Nurse, Kaiser Permanente, Oct 2010 - Mar 2015, San Diego, CA

Utilized the standard of care in the assessment, planning implementation and evaluation of the surgical patient.

Delivery of Pre and Post-Operative surgical care.

Assembled and communicated appropriate information in verbal or written reports. Provided nursing care utilizing clinical knowledge and expertise, reacting immediately to adverse physiological changes within seconds to reverse and revive the patient's physiological functions.

Executed proper use of equipment & supplies used in pre-op and recovery including EKG, IV, heart and vital signs monitors, as well as computer charting. Performed within the established standard of pre and post anesthesia and critical care nursing.

Consulted with healthcare team to implement patient care plans that best benefited patient.

Emergency Room Registered Nurse, Kaiser Permanente, Nov 2008 - Oct 2010, San Diego, CA

Coordinated with other areas of the hospital for patient care such as X-ray, CT, MRI and OR.

Assessed and reassessed pain by utilizing pain management techniques to educate patients and families about pain management.

Initiated and documented accurate and ongoing assessment of physical and psychosocial concerns to treat patients.

Remained aware of patient needs to respond quickly and accurately to changes in condition or response to treatment.

Evaluated and stabilized patients by managing varying acuity and conditions, from minor and non-urgent to critical and emergent.

Leveraged triage process to deliver timely and appropriate care to patients and accurately assign triage categories.

Communicated with physicians about changes in patient status, symptomatology, and results of diagnostic studies to optimize care delivery. Determined priorities of care by measuring physical and psychosocial needs and factors influencing patient flow-through system.

REFERENCES

REFERENCES AVAILABLE UPON REQUEST

EDUCATION

Nursing

Kaplan Univsersity - San Diego, CA

Successful completion of - Associate Degree in Nursing - passing the NCLEX with a perfect score and graduating the top 3 in my class. Currently pursuing a double major Bachelor Science Nursing and Bachelor of Business Administration.

ADDITIONAL INFORMATION

On a personal note, I began working at the age of 15 and since then have purchased homes, raised children, cared for sick parents as well has lost parents. I, as a human have gone through trials and come out the other side successful. I always maintain a glass is half full attitude and firmly believe that living life to its fullest is so important. The word can't is not in my vocabulary. I feel there is always a way. Nothing is impossible and nothing cannot be learned.

While my most recent experience is in Nursing and as of the last few years specifically Utilization Review / Case Management / Discharge Planning - I am capable of most any career path, so if I am applying for a career that may seem out of my scope it is because I know for sure I can learn it and desire to.

I have the critical thinking skills and life experience to jump into a new role and find a lot of success. I am a value to any employer, not just in the Medical Field but in any field because I truly to give my heart to my work. I value work ethic and being a part of a team above all.

I do hope that if you find I don't have the exact set of skills you may be looking for on this resume that you give me a call and talk one on one. If I don't currently have a skill you may need but you are able to teach you have the right person. I am a very fast learner, I have a strong level of common sense and critical thinking. I am quick on my feet and love mastering new skills.

Thank you so much for your consideration.

Autumn Osorio



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