Myra Borlaza Emelia

415-***-****

adz5v9@r.postjobfree.com

Summary

Motivated and empathetic Utilization Review Nurse committed to providing patients and their families with comprehensive care and education. Seeking a position where I can use my case management and interpersonal skills to perform all utilization management review processes. Skills

Professional

• Excellent Customer Service

• Multitasking

• Excellent time management

• Clinical knowledge

• Data Entry

• Collaboration

• Microsoft Office, Epic

• Excellent Organization Skills

• Ability to work under pressure

• Exceptional communication abilities

Clinical

• Knowledge of utilization review and case management

• TAR submission

• Strong understanding of various types of insurance coverages

• Strong knowledge of nursing procedures and medical terminology

• Inpatient care

• Knowledge of state and federal requirements affecting care coordination service Experience

Utilization Technician III – Mills Health Center September 2019 – Current

• Initiate authorizations for inpatient and outpatient admissions

• Review patient admission data and clinical documentation to ensure medical necessity

• Provide concurrent reviews for patients to ensure that extended stays are medically justified and documented in medical records

• Provide supporting data during appeals process, ensuring all necessary documentation is prepared and submitted timely

• Participate in daily multi-disciplinary rounds

• Participate in weekly meetings to ensure accounts have been properly authorized and completed to bill License Vocational Nurse – Mills Health Center October 2013 – 2019

• Charge nurse in Chemical Dependency Unit

• Provide care for adults and adolescents with mental and behavioral health related issues

• Administering medications as ordered by physicians

• Document patient information accurately and efficiently License Vocational Nurse – St. Lukes Hospital October 2002 – 2013

• Caring for patients with tracheostomy

• Administering injections or medications

• Dressing wounds

• Collecting samples for routine lab tests

• Documenting nursing observations and reporting any changes to charge nurse Education

Unitek College Associate of Science in Nursing

NCP Vocational School License Vocational Nurse

Certifications

CPR certification, American Red Cross – 2022

CPI certified - 2023

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