Review Nurse
Resume:
Marie Stephanie T. Galang, RN
Date of Birth 02/17/1988
Nationality Filipino
Currently Residing (including postal code) 13154 Old Saint Augustine Road, Jacksonville, FL 32258
Marital Status Married
Qualification PHRN, USRN, Bachelor of Science in Nursing SUMMARY: Compassionate Registered Nurse with strong background in skilled nursing rehabilitation, medical-surgical and triage. Specializes in coordinating between patients, families and healthcare professionals to facilitate communication and provide optimal care. Seeking to obtain a position as a Utilization Review/Management Nurse.
● SKILLS:
● Worked as a concurrent review nurse by assessing the medical necessity of the condition of the patient while care is being rendered.
● Provides determination based on evidence-based guidelines using MCG and Interqual Criteria.
● Is knowledgeable on ICD10 and CPT codes.
● Finishes quality cases in a timely manner and often exceeds expectations.
● Collaborates well with the healthcare professionals such as MDs, case managers, and social workers to come up with a safe discharge plan for the patients.
● Assists with regards to discharge planning such as recommending home health and DMEs to be ordered before discharging patients.
● Maintains confidentiality concerning treatment and personal information.
● Maintains excellent customer service standards while providing compassionate care.
● Keeps all company systems and data secure and safe, according to company’s policies and HIPAA guidelines.
● Is knowledgeable in using MS Word, Office, Excel and Powerpoint.
● Uses critical thinking with effective time management. Clinical Experience
Worked as Registered Nurse at Philippine General Hospital (Triage unit) from January 2017 up to September 2019.
(Underwent Post Graduate Training at St. Lukes Quezon City in Coronary Care Unit for 3 months)
Worked as Registered nurse in Manila Doctors Hospital from March 29, 2022 up to September 7, 2022 in a medical-surgical unit.
Worked as Charge Registered Nurse under United Methodist Homes and Services from 11/14/2022 until 01/26/2023.
Total Years of Clinical Experience: 3 years and 4 months Telephone Number 1-912-***-****
Email address **************@*****.***
FL RN License Number: RN9615021
License Expiration Date 7/31/2024
License Original Issue Date 11/14/2022
Professional Qualifications:
Name of Qualification University Name and address; Course Start Date
Course End Date
Tertiary School University of Santo Tomas (UST) ;
June 2005
March 25, 2009
Secondary Notre Dame of Greater Manila in
Caloocan City, (NDGM);
June 2001
March 2005
PROFESSIONAL REGISTRATION:
Registered with: Date/Valid till:
PHRN license 02/17/2026
USRN license/s 7/31/2024
BLS Certificate 08/14/2024
KNOWLEDGE OF LANGUAGES:
Language Level of language: English Can speak, understand and write in English. Professional Experience
Employment History
PREVIOUS EMPLOYMENT
For Hospital:
● Registered Nurse at Philippine General Hospital from January 2017 up to September 2019
(triage/ER)
● Underwent Post Graduate Training at St. Lukes Quezon City in Coronary Care Unit for months.
● Medical-Surgical RN at Manila Doctor’s Hospital (from March 29,2022 until September 7, 2022)
● Charge Registered Nurse under United Methodist Homes and Services from 11/14/2022 until 01/26/2023.
For Non-hospital Employment:
● month/year - month/year
06/19/2019 up to 08/01/2022
Position: Utilization Management Review Nurse/Inpatient Care Manager under United Health Care/Optum (SNF clients/patients are in the US) Name of Company: Optum Global Solutions
Employer Address: 5th to 10th Floors, Science Hub Tower 1, Block 38, Campus Ave Cor Turin St, Taguig, Metro Manila 1634
Duties and Responsibilities in Optum:
I worked as an inpatient care manager or UMR (Utilization Management Review Nurse) in Optum Global Solutions (OGS) for more than 3 years. OGS counterpart in the US is United Heath Group (UHG). I handled patients in SNFs who have commercial plans under UHC. I was responsible for checking the UHC commercial policy/plan of the members if they were still eligible for skilled stay. If yes, I would review the charts of members specifically the therapy notes, medication sheet, wound care, progress notes, and safe discharge plan and will compare it with Evidence- Based Guidelines such as MCG and Interqual Criteria. If a member was progressing with therapy, I would approve the member for another week of skilled stay. If the member showed decline or no progress with therapy, I would coordinate/collaborate with the Case Manager/MDS/Social worker of the facility and would suggest an agreed upon LCD and suggest a safe discharge plan. However, If they did not agree with my suggested LCD, I would send the case to the Medical Directors for secondary review and they would be the one to decide if they would approve or deny the member for SKILLED STAY. If they denied members, the MDs would set LCD. Before the member/patient discharges to home, us (case managers/UMR) would make sure that member will have a safe DC plan by usually recommending home health to members & ordering DMEs/Equipments for them. If the member or health care providers of the facility did not agree on the adverse determination of the MD of Optum, we will encourage P2P or Peer to Peer review. If the result is still DENIED, they have the option to file an appeal.
● month/year - month/year
June 18, 2018 - March 7, 2019
Position: Utilization Management Nurse/USRN
Name of Company: Shearwater Health Advisors, Inc.
Employer Address: 35F Netpark Building 5th Avenue, Bonifacio Global City, Taguig, Metro Manila 1634
● month/year - month/year
06/02/2017 - May 16, 2018
Position: Utilization Management Nurse/USRN
Name of Company: Accenture
Employer Address: 7th Floor Robinsons Cybergate 1, Pioneer Street, Mandaluyong, Metro Manila 1554
WORK REFERENCES (Previous employers both covering the last 3 years of work) 1. Name: Lew Castillo
Post title: Supervisor in PACM SNF Telephonic/ Optum Home & Community Name of Company: Optum Global Solutions
Address of Company: 5th to 10th Floors, Science Hub Tower 1, Block 38, Campus Ave Cor Turin St, Taguig, Metro Manila 1634
Telephone No: (1-888-***-**** ext. 673198
Email address: ********.****@*****.***
2. Name: Nichelle Martinez
Post title: Team Leader
Name of Company: Shearwater Health Advisors, Inc.
Address of Company: 35F Netpark Building 5th Avenue, Bonifacio Global City, Taguig, Metro Manila 1634
Telephone No: (63-915-***-****
Email address: N/A
3. Name: Patricia Lim
Post title: UMHR Coordinator
Name of Company: United Methodist Homes & Services Address of Company: 1415 W. Foster Avenue, Chicago IL Telephone No: (1) 773- 802-5636
Email address: N/A
Reference Persons (Relatives and friends) in the US 1. Name: Anne Margaret T. Pounds (sister)
Occupation: Marketing Manager for Gigabits, LLC
Address: 208 Oxford drive, Savannah, Georgia, 31405 Telephone No: 912-***-****
Email address: ****@************.***
2. Name: Margareth L. Shelly (aunt)
Occupation: Nurse practitioner
Address: 7319 hill forest dr dallas tx 75230
Telephone No: 512-***-****
Email address: ****************@*****.***
Contact this candidate