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IRENE JOY Y.

Utlization Review Nurse/ Prior Authorization/ Insurance Verification/ Registered Nurse

Verified
$7/hr

Outline

Looking for Full-Time work (8 hours/day) at $7/hour

Bachelor's Degree

English proficiency Fluent

Professional Summary

Licensed RN with 9 years of combined clinical and healthcare admin experience—expert in utilization review, prior auth, insurance workflows, and crede

Skills & Experience

Skills

Customer Support > Insurance > Prior Authorization 1-2 Years
Office and Administration > Microsoft 365 10+ Years
Medical Terminology 10+ Years
HIPAA Compliance & Healthcare Knowledge 1-2 Years
CPT, CDT, and ICD-10 Coding 1-2 Years

Experience highlights

Utilization Review Nurse
Shearwater Health · June/2023 – Present
Conducted clinical reviews to assess medical necessity, appropriateness, and efficiency of healthcare services. Verified documentation, applied CPT/ICD-10 codes, and ensured compliance with payer guidelines. Collaborated with providers and insurance teams to streamline prior authorization and reduce denials.
Staff Nurse
Alhada Armed Forces Hospital · August/2019 – Present
Provided comprehensive care to postpartum mothers and newborns, including monitoring vital signs, assisting with breastfeeding, managing pain, and educating families on postnatal recovery and newborn care. Ensured timely documentation and collaborated with multidisciplinary teams to support safe discharge planning.
StaffNurse
St. Mary's Maternity and Children's Hospital · August/2015 – Present
Delivered compassionate, age-appropriate care to infants, children, and adolescents. Monitored vital signs, administered medications, supported family education, and collaborated with physicians to manage acute and chronic conditions. Ensured accurate documentation and safety in a fast-paced pediatric unit.
Administrative Assistant
AMCON and Company · February/2012 – Present
Provided administrative support for project coordination, documentation, and scheduling. Managed contracts, vendor communications, and inventory tracking. Ensured smooth office operations by handling reports, filing systems, and team correspondence.
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