Jacqueline Negron

Enfermera graduada UM Clinical Specialist

Talento

BayamonMiembro desde 23 de abril de 2026

Fluent Bilingual English (spoken & written)Active RN Licensure in PR & member of Colegio de Profesionales de Enfermeria de PRComprehensive medical record review, clinical assessment & documentation analysisStrong knowledge of acute/chronic conditions, levels of care & medical necessity determinationConcurrent, retrospective and continued stay reviewsAnalytical thinking, organized time managementMCG & InterQual software and criteria applicationInpatient vs outpatient determinationElectronic Medical Record System, telephonic & virtual review workflowsProficient with Microsoft office (Word, Excel, Outlook)Knowledge ICD10, HCPCS, Inpatient Procedure List, CMS guidelinesEfficient planning, organized and prioritizing task to maximize productivity and meet deadlinesPeer to Peer review preparation and coordination with medical directorsInterdisciplinary collaboration with case management & discharge planningKnowledge in studies & procedures pre authorization process and policy interpretation

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Sobre mí

Proactive BSN, RN Clinical Advisor with extensive experience in the health plan industry, excelling in Utilization Management and compliance. Demonstrated expertise in conducting evidence-based reviews, optimizing care, and training peers. Strong interpersonal communication skills, dedicated to enhancing patient outcomes and ensuring adherence to clinical guidelines.

Experiencia

RN Clinical Advisor (UM Dept) at Humana Health Plan (2006-09 – 2026-01)

Conduct concurrent medical necessity reviews on inpatient cases using evidence-based guidelines and provide training to peers on review processes.

Conduct concurrent medical necessity reviews on inpatient cases using evidence-based guidelines (InterQual & MCG)
Review daily cases onsite/remote across multiple acute care facilities
Determine appropriate level of care and identify opportunities for care optimization
Discuss cases that do not meet criteria with Medical Advisor
Collaborate with physician advisors, case managers, and hospital utilization staff
Support discharge planning and transitions of care
Ensure compliance with clinical guidelines and payer policies
Provide training to peers and new associates on InterQual Guidelines review process and application

Labor & Delivery RN at Ashford Presbyterian Community Hospital (2004-08 – 2006-09)

Assisted in labor induction, monitored fetal heart rates and vital signs, administered medications, and documented patient information accurately.

Assisted in induction of labor using medications or mechanical methods
Monitored fetal heart rates and vital signs of patients in labor to identify potential complications
Administered medication as prescribed by physician to manage pain and facilitate smooth deliveries
Documented patient information accurately in electronic medical records systems per facility guidelines
Evaluated emergency situations promptly and initiated appropriate interventions as needed

ER Registered Nurse at Corporacion De Servicios Integrales De La Montana (2003-07 – 2004-08)

Direct patient contact with prioritized care based on urgency and severity, utilized critical thinking skills, and maintained accurate records.

Direct contact with patients, prioritized patient care based on urgency and severity of condition
Utilized critical thinking skills when making decisions about patient care priorities
Maintained accurate records and charted consistently
Intervened and stabilized patients during emergencies with immediate first aid, CPR or advanced life support care
Administered patient medications accurately and monitored for adverse reactions