Kim Andrew Barraza
Tacloban City
Summary
Detail-oriented Pre Review Nurse with expertise in utilization review and regulatory compliance. Proven ability to conduct comprehensive chart reviews ensuring service and quality are adherence to standards.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Pre-Service Review Nurse
Optum Global Solutions
Makati City
09.2023 - Current
- Perform medical necessity, formulary and non formulary reviews of clinical records using multiple applications including RxClaim and PANDA/Prior Authorization System.
- Followed specific guidelines and job aids to determine the level of care and service utilization.
- Reviews requests for prior authorization (procedures, admissions, diagnostics, medications).
- Conducted comprehensive chart reviews across multiple documentation platforms, ensuring completeness, accuracy, and adherence to regulatory standards.
Staff Nurse
Rural Health Unit
Alangalang Leyte
09.2022 - 06.2023
- Provide primary healthcare services including assessment, triage, and basic treatment for patients in the community.
- Administer immunization programs (EPI) for infants, children, and adults in accordance with DOH guidelines.
- Monitor and manage communicable and non-communicable diseases (e.g., TB, hypertension, diabetes) through screening and follow-up care.
- Assist in disease surveillance and outbreak response, including contact tracing and case monitoring.
- Ensured facility compliance with Department of Health (DOH) regulations and hospital policies.
- Provided direct patient care utilizing strong clinical assessment, critical thinking, and sound nursing judgment.
Emergency Room Nurse
Allied Care Experts Medical Center
Tacloban City
07.2019 - 08.2022
- Rapid assessment, triage, and stabilization of patients presenting with acute, life-threatening, and urgent conditions.
- Delivered direct patient care including medication administration, IV therapy, wound care, and monitoring of vital signs.
- Assisted in emergency procedures such as intubation, resuscitation, and trauma management. Respond to code situations and medical emergencies.
- Collaborated with physicians and multidisciplinary teams to ensure timely and appropriate patient care.
- Ensured adherence to hospital protocols, infection control standards, and patient safety guidelines.
Emergency Room Nurse
Victor R. Potenciano Medical Center
Mandaluyong City
09.2018 - 02.2019
- Performed patient evaluation, prioritization (triage), and immediate stabilization for individuals with critical and emergent conditions.
- Administered comprehensive bedside nursing care, including pharmacologic treatments, intravenous therapy, wound management, and continuous vital signs monitoring.
- Ensured strict adherence to hospital protocols, infection control standards, and patient safety regulations to safeguard health.
- Applied critical thinking and effective prioritization in handling multiple high-risk patients within a high-volume emergency setting.
- Supported and participated in life-saving interventions such as airway management, advanced cardiac life support (ACLS), and trauma resuscitation.
- Worked in coordination with physicians and interprofessional healthcare teams to facilitate prompt and appropriate clinical management.
Customer Support Specialist
Convergys
Mandaluyong City
11.2017 - 04.2018
- Handled inbound and outbound calls related CITI credit card accounts, including billing inquiries, transactions, disputes, and account services.
- Investigated and resolved billing discrepancies and unauthorized transactions, ensuring timely and accurate dispute resolution.
- Navigated multiple banking and CRM systems to access account information and document customer interactions accurately.
- Ensured compliance with banking regulations, data privacy policies, and security protocols when handling sensitive financial information.
Education
Bachelor of Science - Nursing
Arellano University
Pasig, Metro Manila03-2016
Skills
- Proficient in the use of prior authorization systems and applications
- Medical necessity review
- Regulatory compliance
- Quality improvement
- Evidence-based care
- Care coordination
- Critical thinking
- Team collaboration
- Attention to detail
- Emergency response
- Patient safety
- Clinical judgment
Certification
- Registered Nurse, Texas, USA
- Registered Nurse, Philippines
Timeline
Pre-Service Review Nurse
Optum Global Solutions
09.2023 - Current
Staff Nurse
Rural Health Unit
09.2022 - 06.2023
Emergency Room Nurse
Allied Care Experts Medical Center
07.2019 - 08.2022
Emergency Room Nurse
Victor R. Potenciano Medical Center
09.2018 - 02.2019
Customer Support Specialist
Convergys
11.2017 - 04.2018
Bachelor of Science - Nursing
Arellano University