Jacqueline Negron

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.

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

Bachelors Degree in Nursing Sciences – University of Puerto Rico, Mayagüez (2003)