Vanessa Daniel

RN Case Manager and clinical operations leader with 20+ years of experience in case management, utilization review, discharge planning, care transitions, and multidisciplinary leadership. Uses InterQual and MCG criteria, regulatory requirements, and patient-centered care planning to guide utilization decisions, coordinate safe transitions, improve member outreach, and support quality and compliance.

Private Duty Nurse at Connect Pediatrics (2026-09 – Present)

• Deliver individualized in-home nursing care by administering prescribed medications, monitoring vital signs, documenting findings, and escalating changes in condition to the appropriate provider.
• Execute the physician-directed plan of care while supporting activities of daily living, safety, comfort, and continuity of care.

Family Caregiver (2022-01 – 2026-02)

• Provided round-the-clock care to maintain safety, comfort, and continuity of care.
• Coordinated in-home therapies and support services to streamline care delivery.

Telephonic Case Manager at A-Line Staffing Solutions (2022-07 – 2022-11)

• Managed complex cases by coordinating patient-centered plans of care, monitoring clinical progression, and supporting safe discharge planning, care transitions, and appropriate resource utilization.
• Connected patients and families with community-based resources and support services to address psychosocial needs, reduce barriers to care, and support post-acute planning.
• Served as a liaison among patients, families, physicians, and the multidisciplinary team to strengthen communication, align care plans, and support coordinated care transitions.

Supervisor for Star Kids at Cook Children's Health Plan (2018-01 – 2021-12)

• Recruited, trained, and supervised a team of 18 nurses and social workers to support high-quality case management operations.
• Set clear performance expectations and foster collaboration to improve team accountability and results.
• Streamlined workflows and applied sound clinical judgment to maintain team efficiency and meet daily operational demands.
• Monitored productivity and resource utilization to support operational goals and consistent team performance.

Supervisor Utilization Management Nurse at Health Smart (2014-09 – 2017-12)

• Partnered with providers to obtain clinical documentation, apply InterQual criteria, and support timely utilization review determinations, recommendations, and case management actions.
• Created a Behavioral Health Utilization Management request form that standardized coverage requests for inpatient, outpatient, and intensive outpatient program services.
• Developed and implemented utilization management policies and procedures that improved efficiency, supported appropriate resource utilization, and strengthened patient throughput.
• Led and mentored utilization management nurses to ensure consistent application of policies, clinical criteria, quality standards, and performance expectations.

Clinical Operations Unit Manager at BCBSTX (2013-10 – 2014-08)

• Improved team morale and retention through responsive leadership, timely issue resolution, and a supportive work environment.
• Directed clinical operations and enforced compliance with federal, state, and healthcare regulatory requirements.
• Educated patients and caregivers on diagnoses, treatment plans, disease management, and available healthcare resources so they could make informed care decisions consistent with their needs, values, and rights.
• Helped develop procedure manuals and in-service programs while proactively addressing survey readiness and standards-of-care issues.
• Oversaw patient care and clinic services to improve quality outcomes, safety, regulatory compliance, resource utilization, and transitions across the continuum of care.

Bachelor of Science in Nursing – Texas Christian University

Bachelor of Arts in Sociology – William Woods University