Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

MARY GRACE PEREZ

Imus, Province Of Cavite

Summary

Accomplished Clinical Review Nurse with a proven track record at Shearwater Health, enhancing patient satisfaction and streamlining workflows. Expert in HIPAA compliance and ethical practice, demonstrating exceptional teamwork and time management skills. Achieved significant improvements in clinical review processes, contributing to cost containment and increased productivity levels.

Experienced healthcare professional prepared for role with strong background in clinical review and patient care. Expertise in evaluating medical records, ensuring compliance with regulatory standards, and facilitating effective communication between healthcare providers. Known for collaborative approach, reliability, and adaptability to changing needs. Skilled in utilization review, case management, and healthcare documentation, with focus on achieving measurable results.

Overview

10
10
years of professional experience
1
1
Certification

Work History

Clinical Review Nurse

Shearwater Health
12.2022 - 09.2024
  • Collaborated with billing department to resolve discrepancies in claims processing, resulting in accurate reimbursement for services rendered.
  • Enhanced patient satisfaction by addressing concerns related to their clinical management plan in a compassionate manner.
  • Participated in performance improvement initiatives aimed at streamlining workflows within the organization, contributing to increased productivity levels across departments.
  • Maintained strict adherence to HIPAA regulations during all clinical review activities, ensuring patient confidentiality was upheld at all times.
  • Contributed to cost containment initiatives by identifying potential overutilization of resources and recommending alternative treatment options.
  • Streamlined workflow processes by identifying gaps in clinical documentation and providing timely feedback to providers.
  • Maximized efficiency within the department by organizing workload according to priority level, ensuring deadlines were met consistently.
  • Improved patient care by conducting thorough clinical reviews and recommending evidence-based interventions.
  • Facilitated timely discharge planning through comprehensive review of patients'' medical records and coordinating with multidisciplinary teams.

Project Development Officer II (GRS)

Department Of Social Welfare and Development -NCR
09.2015 - 09.2022
  • Implemented quality control measures to ensure deliverables met or exceeded client requirements.
  • Streamlined communication channels for improved collaboration among cross-functional teams.
  • Secured necessary permits and approvals from regulatory authorities in a timely manner, avoiding costly delays in project execution.
  • Optimized resource utilization by continuously monitoring progress against timelines and adjusting allocation as required.
  • Review and analyze grievance reports and verify.
  • Ensure availability of grievance forms.
  • Facilitated of retroactive payment of Pantawid Pamilya beneficiaries
  • Monitored the updating in the GRS database (including immediate encoding of GRS forms filed/received through various modes such as; Snail Mails (endorsed cases from Field staff), SMS, Social networking sites, Memos, and feedback to RGO.
  • Submitted reportorial requirement in compliance to the Secretary's directives, to the National Program Manager and CSC Hotline 8888.
  • Provide feedback to Secretary's directives, to the National Program Manager and CSC Hotline 8888 with appropriate resolution in a timely manner.
  • Monthly Accomplishment Reports, Quarterly Accomplishment Report and Annual Report.


Project Development Officer II ( City Link)

Department Of Social Welfare and Development-NCR
09.2015 - 01.2017

⮚ Prepare activity proposals and other budgetary requirements at the municipal level in coordination with other ML’s in the municipality

⮚ Facilitate conduct of supply side assessment in coordination with focal persons of partner agencies and the LGU

⮚ Facilitate conduct of community assembly in collaboration with the Local Government and other partner agencies

⮚ Monitor and prepare report on compliance on supply side requirements of the program in coordination with partner agencies and the LGU

Facilitate and conduct Family Development Sessions with the LGU links and parent leaders as organizers and

Utilization Nurse Reviewer

HCCA Health Connections
06.2014 - 12.2014
  • Assisted in reducing hospital readmissions through careful evaluation of discharge plans and follow-up care recommendations for high-risk patients.
  • Increased efficiency in case processing times by utilizing advanced software systems for case management and documentation purposes.
  • Improved patient outcomes by conducting thorough case reviews and offering clinical recommendations.
  • Contributed to the development of improved clinical guidelines by participating in interdisciplinary committees and sharing expertise on best practices.

Education

Bachelor of Science - Nursing

Lyceum Northwestern University
Dagupan City Pangasinan
04-2001

Skills

  • Vital signs monitoring
  • HIPAA compliance
  • Patient confidentiality
  • Clinical assessment
  • Ethical practice
  • Teamwork
  • Time management
  • Compassionate and caring
  • Multitasking Abilities

Certification

  • Registered Nurse License (RN) - State Board of Nursing ( Texas State)

Timeline

Clinical Review Nurse

Shearwater Health
12.2022 - 09.2024

Project Development Officer II (GRS)

Department Of Social Welfare and Development -NCR
09.2015 - 09.2022

Project Development Officer II ( City Link)

Department Of Social Welfare and Development-NCR
09.2015 - 01.2017

Utilization Nurse Reviewer

HCCA Health Connections
06.2014 - 12.2014
  • Registered Nurse License (RN) - State Board of Nursing ( Texas State)

Bachelor of Science - Nursing

Lyceum Northwestern University
MARY GRACE PEREZ