Senior Clinical Analyst (Utilization Review Nurse)
Resume:
PRINCESS LOUISE B. JOVER, RN
Address: **** ******* **., *** ****
Sioux City, Iowa 51106 USA
Phone: 712-***-****
Email: adxool@r.postjobfree.com
Skype ID: Louise Jover
Professional Qualifications
• Goal-oriented, highly passionate, and adaptable RN with experience in different clinical areas providing nursing care and with a solid background in utilization management. Education
Bachelor of Science in Nursing
• West Visayas State University, La Paz, Iloilo City (June 2013 -March 31, 2017) Professional Affiliations and Honors
• MEMBER, West Visayas State University Federated Alumni Association, Inc.
• MEMBER, Philippine Nurses Association
• PARTICIPANT, 9th National Nursing Research Conference, Philippine Nursing Research Society, Inc. (Research title: POSTER PRESENTATION: GUIDANCE NEEDS OF NURSING STUDENTS IN SELECTED SCHOOLS IN ILOILO CITY- POSTER PRESENTATION)
• Feature Writer -The Lifeline West Visayas State University - College of Nursing Publication Examinations/Certifications
Examinations/Certifications Result/Status
NCLEX PASSED, July 18, 2019
PH Board Exam PASSED, June 2017
BLS and ACLS Certified BLS and ACLS provider
Professional License
• State of Licensure: Iowa
o License Number: 172021
o Valid Until: February 15, 2025
Areas of Expertise
• Utilization Management (3 years)
• Skilled nursing (6 months)
• Obstetrics and Gynecology Emergency Room (1 month)
• St. Vincent Ward (Surgical Semi-Private) (1 month)
• Orthopedic Ward (1 month)
• Trainings on BLS ACLS, Intravenous Therapy and seminars (1 month) Employment History
• Registered Nurse (December 5, 2022 – April 6, 2023) o Employer: MercyOne Skilled Nursing Facility
o Employer Address: 624 Jones St., Sioux City, IA 51101 Comprehensive Job Description:
Under limited supervision, provides nursing care to assigned patients by utilizing the nursing process and meeting the established standards within the nursing department. The registered nurse is accountable for his/her nursing practice and assigned patients and is an advocate for patient/families and nursing. Adheres to the principles of Service Excellence Guiding Behaviors and the philosophy and mission of Mercy in all aspects of job performance.
• Senior Clinical Analyst (January 25, 2021 – July 15, 2022) o Employer: Accenture, Inc. (Blue Cross Blue Shield of Arizona) o Employer Address: Uptown Tower 2, 5 East 11th Drive, Uptown Bonifacio, Taguig City 1634 Comprehensive Job Description:
1. Reviewing prior authorization and retrospective requests in Arizona and some other states for medical necessity according to lnterQual and Evicore guidelines. 2. Ensuring that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing patient treatment files, the utilization nurse will ensure that patients won't receive unnecessary procedures, ineffective treatment, or unnecessarily extensive hospital stays.
3. Calling providers to inform them of the status of the case and request clinical information.
• Nurse Medical Management I (September 30, 2019 – May 30, 2020) o Employer: Legato Health Philippines (Anthem)
o Employer Address: 9th Floor World Commerce Place Tower 2 Taguig City Comprehensive Job Description:
1. Reviews medical requests in mainland states according to a regulatory body's guidelines for approval.
2. Verifies request information gaps and incongruences through a courteous and effective communication.
3. Receives calls for live review or follow up of certain requests.
• Clinical Administrative Coordinator for Medicare and Retirement (August 10, 2018 – May 15, 2019) o Employer: Optum Global Solutions (United Health Group) o Employer Address: Science Hub Tower 1, Turin St, Taguig City Comprehensive Job Description:
1. Serves individuals, states and communities, military families and veterans in mainland states and brings them resources of commitment to improve their lives that's second to none. 2. Approve or pend medical requests per medical guidelines for Medicare and Retirement. 3. Verifies requested information gaps and incongruencies through courteous and effective communication.
• Post-Graduate Practicum Nurse Trainee (September 5, 2017 – January 15, 2018) o Employer: Western Visayas Medical Center
o Employer Address: Q. Abeto St, Mandurriao, Iloilo City Comprehensive Job Description:
1. Assess, plan, implement and evaluate nursing care plans to facilitate optimal patient care. 2. Assures quality of care by adhering to therapeutic standards; measuring health outcomes against patient care goals and standards; making or recommending necessary adjustments; following hospital and nursing division's philosophies and standards of care set by state board of nursing, state nurse practice act, and other governing agency regulations. 3. Maintains continuity among nursing teams by documenting and communicating actions, irregularities, and continuing needs.
4. Performs IV insertion, total body patient assessments, medication administration, assist in diagnostic procedures, etc.
Personal Information
Date of Birth: February 7,1996
Birth Place: Iloilo City, Philippines
Gender: Female
Marital status: Single
Social Media Account Information: Facebook Messenger- Princess Louise Jover Emergency Contact
Name: Alex Awerkamp
Relationship: Significant other
Mobile number: 618-***-****
Email address: adxool@r.postjobfree.com
Home Address: 5701 Christy Rd. Apt. 1201
Sioux City, IA 51106
Character References
Chloe Hassett
Supervisor
Health Carousel
Daisy D. Daduya, R.N.
Nurse Ill, Supervisor
Orthopedic Ward Western Visayas Medical Center
02-8942-6843
William Reyes Jr., RN
Supervisor, Clinical Coverage Review (Medicare and Retirement Prior Authorization) United Health Group
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