Case Manager Utilization Management
Resume:
Thelma De
Guzman
RN CASE MANAGER
Details
Colton
United States
adwas6@r.postjobfree.com
Skills
BLS
Medicare & Medicaid Regulations
Cerner
Microsoft Outlook
Microsoft Office
Communication
Ability to Work Under Pressure
Hobbies
Gardening, walking, cooking, and
listening to podcasts
Profile
Dedicated Nurse with the ability to multitask and work well with others. Patient-care oriented, bringing forth a compassionate and friendly attitude. A nurse who works well under pressure, and exudes positivity. Education
BSN, Adventist University of the Philippines, Silang Cavite Philippines J UNE 1 9 7 5 — MARCH 1 9 8 0
Master in Public Health, Adventist University of the Philippines, Silang Cavite Philippines
F EBRUARY 1 9 8 5 — MARCH 1 9 8 7
Employment History
RN Utilization Management (Remote), Adventist Health System, Roseville S E P T EMBER 2 0 2 1 — DECEMBER 2 0 2 2
• Conduct utilization management & Reviews 25-30 patients to determine medical necessity, ensure appropriateness of care and level of care using Interqual Criteria by Mckensson
RN Utilization Management, Adventist Health: Glendale, Glendale AUGUST 2 0 1 4 — AUGUST 2 0 2 1
• Conduct utilization management & Reviews 25-30 patients to determine medical necessity, ensure appropriateness of care and level of care using Interqual Criteria by Mckensson
• Dealt with case denials and appeals
RN Case Manager, Adventist Health White Memorial, Los Angeles F EBRUARY 2 0 1 0 — AUGUST 2 0 1 4
• Conduct Case management & some utilization management in Med/Surg/Telemetry/ICU patients to determine medical necessity, ensure appropriateness of care and level of care
• Facilitate patient's achievement wellness and autonomy through advocacy, assessment, planning, monitoring, education, resources management and service facilities availability
• Consulting, negotiating, collaborating in interdisciplinary approaches
• Discharge planning, resources management, coordination of care to all team members to post acute care
Telemetry RN (Charge Nurse Reliever/Preceptor), Adventist Health White Memorial, Los Angeles California
OCTOBER 2 0 0 7 — AUGUST 2 0 1 0
• Monitored patients with heart disease and other serious medical conditions using an electrocardiogram or other vital sign measuring devices
• Monitoring, interpreting, and recording data from specialized medical equipment.
• Administering medication and performing treatment interventions in consultation with healthcare specialists.
• Oversees 6 South Telemetry unit, delegating nursing duties and assignments, coordinating schedules, monitoring admissions and discharges
• Educated new grad RN's in meeting clinical objectives and delivering safe and quality patient care
Telemetry RN (Float ICU), Adventist Health: Glendale, Glendale DECEMBER 2 0 0 3 — OCTOBER 2 0 0 7
• Aimed to continually grow and learn as a Nurse
• Assisted hospital staff and other RN's in day to day tasks in accordance with patient care plans and physician's orders
• Communicated information and guidelines to patients and the families of patients
• Worked well both independently and in team settings Clinical Instructor, Adventist University of the Philippines, Silang Cavite Philippines
J UNE 1 9 8 9 — APRIL 2 0 0 2
• Coordinated internship programs for students seeking clinical work in the area.
• Remained committed to helping each student grow and learn as an academic scholar/Clinical experiences.
• Continually offered a variety of teaching methods and curricular perspectives.
• Treated students and faculty with the utmost respect and courtesy.
• Informed all students of classroom and program policies and procedures. Courses
Case Management 3-days course, California Medical Audit, Inc APRIL 2 0 1 0 — APRIL 2 0 1 0
EKG Refresher one day Course, White Memorial Medical Center J UNE 2 0 0 9 — J UNE 2 0 0 9
White Memorial Medical Center Emergency 5- days Course, White Memorial Medical Center
OCTOBER 2 0 0 8 — OCTOBER 2 0 0 8
Critical Care Internship Training, Glendale Adventist Medical Center S E P T EMBER 2 0 0 3 — OCTOBER 2 0 0 3
Clinical and Academic Internship, Loma Linda University APRIL 2 0 0 1 — MAY 2 0 0 1
References
Angela Hughes from former Case manager Director of Adventist Health Memorial
Marilou Wijenayake from House Supervisor of Adventist Health White
Gemma Bitoonon from Former Manager of CMRC Adventist Health Glendale
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