Prior Authorization Case Manager
Resume:
Naga City
Cebu, Philippines
************@*****.***
Jane Cejodo Alfajardo, RN
SKILLS
Medication Administration
Medical Record Management
Medical Knowledge
Communication Skills
Team Collaboration
Patient Education and Advocacy
Outbound/ Inbound call handling
HIPAA Compliance
WORK EXPERIENCE
Xtendops, Cebu Philippines- Prior Authorization Nurse July 2024- November 2024
● Process prior authorization via portals, over the phone and via fax
● Follow up payers regarding the status of submitted or pending authorization request via phone call
● Update the notes EMR in case there are new updates regarding the status of the prior authorization. Activeone, Cebu Philippines — Company Nurse
September 2022 - May 2023
● Assist physician during consultation by taking vital signs
● Updating EMR of the patient
● Dispense over the counter medication after careful assessment of the patient. PhilCAT, Cebu Philippines — Notification Project Officer October 2021 - May 2022
● Database management for TB cases.
● Visit the provider's office for collection of TB cases. Shearwater Health, Cebu Philippines — Triage Nurse May 2019 - October 2021
● Verify patient’s claim for eligibility
● Process request number and send it to the next person to process the claim.
● Coordinate with the case manager and do outbound calls to the provider's office for any missing information. OPTUM, Cebu Philippines — Pharmacy Fulfillment Clerk May 2015 - February 2018
● Database management by indexing patient information from charts we received from provider’s office
● Do outbound calls to the provider's office to verify information and assist them in completing the prior authorization request .
Adventist Cebu Hospital, Cebu Philippines - Volunteer Nurse August 2009 – October 2009
Areas: Surgical Ward, Medical Ward, ER, ICU, Pediatric Ward
● Implements/develops/documents the plan of care and revises as necessary
● Perform other duties as assigned
● Makes routine rounds on each assigned resident and patient in accordance with established procedures
● Assist in the implementation of an individualized treatment plan for each assigned patient Private Duty Nurse
2008- 2011
- Handled multiple patient (All, Crohn’s Disease, Alzheimer's Disease, CVA) Responsibilities:
● Do bedside care like bed bath, shampoo, perineal care, and feeding
● Administer medication and monitor vital signs
● Assist in ADL and during therapy session
● Report any abnormalities to primary care physician Dermstrata Skin Clinic, Quezon City - Therapist/Aesthetician March 2012 - October 2012
● Do skin analysis or assessment to patient on what are the needed treatment
● Perform body and facial treatments.
● Educate patients on proper skin care and instruct patients about their medications. Abot Kamay Pharmacy, Quezon City - Pharmacy Assistant November 2011 - March 2012
● Dispense prescription medication and other medical products under the direction of a pharmacist.
● Educate customers and give information regarding their medications. EDUCATION
Southwestern University, Cebu City Philippines — Bachelor of Science in Nursing June 2003 - March 2007
LICENSES
PRC Philippine Registered Nurse
CERTIFICATION
Basic Occupational Safety and Health
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