Summary
Overview
Work History
Education
Skills
Certification
ADDITIONAL PROFICIENCIES
Timeline
Hi, I’m

ARLENE JOY JOSE

NURSE
Roxas City
ARLENE JOY JOSE

Summary

Dedicated and compassionate professional with seven years of nursing experience and a solid background in customer service and utilization review. Currently working remotely as a Utilization Review Nurse at Cebu Mabuhay Shearwater Health. Proven ability to manage clinical evaluations independently, meet deadlines, and communicate effectively in virtual environments. Seeking to leverage healthcare expertise, strong communication skills, and remote work efficiency in a customer-focused role to enhance client satisfaction and contribute to organizational success.

Overview

11
years of professional experience
2014
years of post-secondary education
6
Certifications
4
Languages

Work History

Shearwater Health - Philippines

Utilization Review Nurse
09.2024 - Current

Job overview

  • · Conduct remote clinical reviews to determine medical necessity of requested treatments using standardized guidelines such as InterQual and MCG.
  • · Communicate professionally with healthcare providers and adjusters through secured platforms to request clarifications and ensure accurate case resolution.
  • · Work independently in a home-based setup, demonstrating strong time management, focus and reliability in meeting daily case review qoutas and deadlines.
  • · Document clinical recommendations and rationale clearly using internal systems while ensuring confidentiality and compliance with HIPAA standards.
  • · Utilized multiple software platforms simultaneously while maintaining productivity in a fast-paced remote environment.
  • · Participate in online training sessions, team meetings, and process calibrations to align with client expectations and regulatory updates.
  • · Demonstrate adaptability, strong attention to detail, and critical thinking in a fast-paced, remote healthcare environment.

ePerformax Contact Center & BPO

Customer Service Representation
02.2024 - 06.2024

Job overview

  • Respond to Inquiries: Handled a high volume of incoming calls, emails, and chat messages, addressing customer inquiries and providing accurate information.
  • Issue Resolution: Resolved customer complaints and issues promptly and professionally, ensuring high customer satisfaction.
  • Product Knowledge: Maintained thorough knowledge of company products and services to provide informed assistance to customers.
  • Record Keeping: Documented customer interactions and transactions, recording details of inquiries, complaints, and actions taken in the CRM system.
  • Customer Education: Educated customers on product usage, troubleshooting, and maintenance, helping them to maximize product benefits.
  • Team Collaboration: Worked closely with team members and other departments to resolve complex issues and improve overall service quality.
  • Feedback Collection: Collected and reported customer feedback to management to assist in improving products and services.
  • Performance Metrics: Consistently met or exceeded performance metrics, including response times, resolution times, and customer satisfaction scores.
  • Continuous improvement: Participated in training sessions and workshops to enhance product knowledge and customer service skills.

Al-Masif Al-hadith Medical

Emergency Room Nurse
10.2016 - 08.2023

Job overview

  • Patient Triage: Assessed patients' conditions and prioritized treatment based on the severity of their injuries or illnesses.
  • IV Therapy and Medication Administration: Administered intravenous medications, fluids, and blood products, ensuring proper dosages and monitoring patient reactions.
  • Diagnostic Testing: Conducted and interpreted diagnostic tests, such as ECGs, blood tests, and imaging, to assist in rapidly diagnosing conditions.
  • Documentation: Maintained accurate and thorough patient records, documenting assessments, treatments, medications, and patient responses.
  • Infection Control: Adhered to strict infection control protocols, including the proper use of personal protective equipment (PPE) and sterilization procedures.
  • Collaboration: Worked closely with a multidisciplinary team, including physicians and specialists, to coordinate patient care and treatment plans.
  • Face multiple patients with different needs, stages of health, and risks.
  • Sympathetic to a patient's needs and able to deal with people in various states of pain, trauma, and tragedy.
  • Being able to function in the heat of an emergency is necessary.
  • Help people.

Yap Medical Clinic

Clinic Nurse
04.2015 - 03.2016

Job overview

  • Assess, plan, implement, and evaluate individual patient's care according to standards.
  • Maintained accurate patient medical records by recording medical history, vital statistics, and test results.
  • Evaluate patient care needs, prioritizing treatment and maintaining patient flow.
  • Performing some medical procedures, including temperature, pulse, and blood pressure readings, TB testing, and EKGs.
  • Scheduled outpatient procedures and specialist appointments, communicating pertinent.
  • Handled patient pharmacy needs by phoning in prescriptions to preferred pharmacies and assisting with the application and processing of medical assistance through pharmaceutical companies.
  • Assisting physicians with procedures.
  • Able to work in other areas according to the skill of staff and acuity of the patient.

Justice Josue Bellosillo

Private Duty Nurse
12.2014 - 02.2015

Job overview

  • Completes assessment of the patient and documents in the medical record.
  • Analyze the information collected to determine the patient's needs and expected outcomes.
  • Observes, evaluates, and reports symptoms and conditions of patient.
  • Develop a plan of care based on the assessment, diagnosis, and expected outcome of the patient.
  • Administrations of medications, monitor patients' response to medication, and documents.
  • Repair equipment needed by the patient and assist physicians.
  • Assist in carrying out patient's procedures and doctor's orders according to accepted standards.
  • Applies Specific principles in performing nursing procedures and techniques.

Education

COLLEGE OF ST. JOHN ROXAS De LaSalle
Roxas City, Capiz

Bachelor of Science from Nursing

University Overview

Supervised

Skills

Utilization Review & Medical Necessity Evaluation (InterQual & MCG)

Certification

Registered Nurse (RN)

ADDITIONAL PROFICIENCIES

ADDITIONAL PROFICIENCIES
  • High Stress Tolerance & Adaptability
  • Strong Multitasking & Problem solving Ability
  • Computer & Software Proficiency (MS Office, CRM, Remote tools)
  • Proven team player, fast learner, and works well under minimal supervision

Timeline

Utilization Review Nurse
Shearwater Health - Philippines
09.2024 - Current
Customer Service Representation
ePerformax Contact Center & BPO
02.2024 - 06.2024
Emergency Room Nurse
Al-Masif Al-hadith Medical
10.2016 - 08.2023
Clinic Nurse
Yap Medical Clinic
04.2015 - 03.2016
Private Duty Nurse
Justice Josue Bellosillo
12.2014 - 02.2015
COLLEGE OF ST. JOHN ROXAS De LaSalle
Bachelor of Science from Nursing
03.2013

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