Summary
Overview
Work History
Education
Skills
Timeline
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Christian Gesulga

Christian Gesulga

Utilization Reviewer-Quality Analysts
Cebu City

Summary

Dynamic Utilization Review Nurse with expertise from Shearwater Health in clinical assessment and documentation analysis. Proven track record in enhancing quality improvement initiatives and securing insurance coverage, while effectively managing denial prevention. Skilled in navigating healthcare regulations and fostering collaboration between providers and insurers to optimize patient care.

Overview

7
7
years of professional experience

Work History

Utilization Review Nurse

Shearwater Health
09.2018 - Current
  • Medical Necessity Review: Examine medical records to ensure treatments meet established guidelines, reducing unnecessary services.
  • Documentation Analysis: Review patient charts for accuracy, including clinical findings, diagnostics, and treatment progression.
  • Insurance Coordination: Act as a liaison between healthcare providers and insurers to secure coverage.
  • Denial Prevention & Management: Conduct concurrent reviews during treatment to avoid, or retrospective reviews to appeal, denied claims.

Education

Bachelor of Science - Nursing

University of The Visayas
Cebu
03.2014

Skills

Clinical assessment

Quality improvement

Healthcare regulations

Documentation and reporting

Utilization review

Timeline

Utilization Review Nurse

Shearwater Health
09.2018 - Current

Bachelor of Science - Nursing

University of The Visayas
Christian GesulgaUtilization Reviewer-Quality Analysts