MA.VICTORIA DE CASTRO
CLOVIS
Summary
Experienced Utilization Review RN and Patient Care Coordinator Case Manager with expertise in medical necessity criteria, regulatory compliance, and discharge planning. Skilled in critical thinking and decision-making, enhancing patient care coordination and optimizing healthcare service delivery.
Overview
33
33
years of professional experience
Work History
ED Case Manager Utilization Review RN
Saint Agnes Medical Center
Fresno
12.2017 - Current
- Case Management Social Services and UM Department
- Assisted in different roles based on requirements.
- Coordinated care plans with multidisciplinary teams for patient support.
- Assessed patient needs and Review for Medical Necessity
- Monitored patient progress through concurrent utilization review
ED Case Manager, Patient Care Coordinator, Case Manager
Kaiser Permanente Medical Center
Fresno
04.2017 - Current
- Case Management/Social Services, Utilization Management Department
- Part-Time
- Coordinated patient care services with the medical team to ensure quality and timely delivery of care.
- Assessed patient's need for additional resources such as home health aides or durable medical equipment suppliers in order to provide appropriate level of care.
- Collaborated with multidisciplinary teams in order to provide comprehensive patient centered care.
- Managed patient admission and discharge processes, ensuring smooth transitions.
- Conducted comprehensive utilization reviews for healthcare services and procedures.
Command Center Interim Supervisor
Community Regional Medical Center
Fresno
04.2015 - 07.2015
- Command Center
- Full Time
- Supervised daily operations of patient care teams in a fast-paced healthcare environment.
- Coordinated staff schedules to ensure adequate coverage and efficient workflow.
- Trained new employees on hospital protocols and patient care standards.
Utilization Review RN/Coordinator
Community Regional Medical Center
Fresno
01.2013 - 04.2015
- Coordinated operations in command center to ensure efficient processing of utilization reviews
- Full time
- Conducted comprehensive reviews of patient treatment plans for medical necessity.
- Collaborated with healthcare teams to ensure compliance with utilization guidelines.
- Evaluated clinical documentation for accuracy and completeness in patient cases.
Utilization Review/Coordinator ED
Community Regional Medical Center
Fresno
09.2011 - 01.2013
- Work Full Time
- Oversaw case files for department clients, ensuring proper documentation and compliance with utilization review standards
- Coordinated utilization review processes to ensure compliance with medical guidelines.
- Reviewed patient records for appropriateness of care and resource allocation.
- Collaborated with healthcare providers to clarify treatment plans and service needs.
Utilization Review/Coordinator ED
Community Regional Medical Center
Fresno
03.2011 - 09.2011
- Coordinated case files to ensure compliance with review protocols
- Delivered per diem services to support patient care and resource allocation
- Conducted comprehensive reviews of patient care plans for medical necessity.
- Collaborated with healthcare teams to ensure adherence to utilization guidelines.
- Analyzed treatment data to identify patterns in resource usage and patient outcomes.
Case Manager
SAMC
Fresno
08.2010 - 08.2011
- Managed caseload in fast-paced environment, ensuring timely support for clients' needs.
- Worked as a per diem case manager from August 2011 to April 2017, collaborating with different teams.
- Coordinated client assessments and developed personalized care plans.
- Facilitated communication between clients and healthcare providers.
- Monitored client progress and adjusted care plans and discharge plan as needed.
Staff Nurse
St Agnes Medical Center
Fresno
08.2009 - 08.2010
- Telemetry Department
- Provided direct patient care in various clinical settings.
- Administered medications and monitored patient responses effectively.
- Collaborated with healthcare teams to develop care plans.
Staff Nurse
Albany Medical Center
Albany
12.2006 - 07.2009
- Supported recovery phases after cardio thoracic surgeries.
- Provided direct patient care and support in diverse clinical settings.
- Administered medications and monitored patient responses to treatment plans.
- Collaborated with healthcare teams to develop comprehensive patient care strategies.
Nurse Extern -PCA (Patient Care Associate)
Albany Medical Center
Albany
06.2006 - 12.2006
- Post Cardio Thoracic Surgery
Full time Clinical Instructor
STI
San Pablo City
06.2005 - 04.2006
- Designed and implemented clinical training programs for nursing students.
- Mentored students in patient assessment and care techniques.
- Coordinated classroom lectures and hands-on practice sessions.
- Evaluated student performance through practical assessments and feedback.
Staff Nurse
San Jose District Hospital
San Jose Batangas City
06.1993 - 03.2006
- Administered medications and treatments as per physician orders.
- Monitored patient vital signs and reported changes to healthcare team.
- Collaborated with multidisciplinary teams to create patient care plans.
- Educated patients and families on health management and recovery processes.
- Trained new nursing staff on hospital policies and best practices.
Part-time Clinical Instructor
University of Batangas
Batangas
06.2004 - 06.2005
- Developed engaging lesson plans for nursing and healthcare students.
- Facilitated hands-on training sessions in clinical settings.
- Evaluated student performance through assessments and practical exams.
- Mentored students in clinical practices and professional ethics.
- Collaborated with faculty to enhance curriculum effectiveness.
Part-time Clinical Instructor
Lyceum of Batangas
Batangas
06.2002 - 06.2004
- Developed engaging lesson plans for nursing and healthcare students.
- Facilitated hands-on training sessions in clinical settings.
- Evaluated student performance through assessments and practical exams.
- Mentored students in clinical practices and professional ethics.
- Collaborated with faculty to enhance curriculum effectiveness.
- Assessed student competency levels through direct observation in the hospital setting.
Education
Master of Arts - Nursing
Golden Gate Colleges Graduate School
Batangas City, Philippines01.2002
Bachelor of Science - Nursing
Lyceum of Batangas
Batangas City, Philippines01.1992
Secondary Education -
St. Joseph Academy
San Jose, Batangas, Philippines01.1988
Primary Education -
Aya Elementary School
San Jose Batangas, Philippines01.1984
Skills
- Patient assessment
- Utilization management
- Utilization review -using InterQual and MCG
- Care coordination
- Case management
- Discharge planning
- Crisis intervention
- Psychosocial assessment
- Case needs assessment
- Risk assessment
- Insurance regulations
- Healthcare policies
- Quality assurance
- Documentation proficiency
- EPIC charting
- Interdisciplinary Team collaboration
- Referral coordination
- Resource management
- Resource identification
- Community resources
- Patient advocacy
- Patient education
- Family education
- Client relationship management
- Effective communication
- Verbal and written communication
- Clear communication
- Active listening
- Conflict resolution
- Time management
- Organization and multitasking
- Shared governance
- Staff education and training
- Goal setting
- Problem solving
- Critical thinking
- Relationship building
- Financial resource management
- HIPAA compliance
- Regulatory compliance
- Court mandated reporter
- Medical necessity assessment
- Training and mentoring
References
- Daniella Gross RN, Case Manager, Kaiser Permanente Medical Center, Fresno, CA, 559-779-5121
- Sheila Brillante RN, Department Manager, Kaiser Permanente Medical Center, Fresno, CA, 559-352-2358
Eligibility
- 09/01/25, CERTIFIED CASE MANAGER
- 07/31/09 to Present , Registered Nurse, California State
- Current BLS Certification
- Preceptor Certification
- ANA Member
- PNACC Member
- 04/19/04, CGFNS Certification
- 01/01/92, Registered Nurse, Philippines
Timeline
ED Case Manager Utilization Review RN
Saint Agnes Medical Center
12.2017 - Current
ED Case Manager, Patient Care Coordinator, Case Manager
Kaiser Permanente Medical Center
04.2017 - Current
Command Center Interim Supervisor
Community Regional Medical Center
04.2015 - 07.2015
Utilization Review RN/Coordinator
Community Regional Medical Center
01.2013 - 04.2015
Utilization Review/Coordinator ED
Community Regional Medical Center
09.2011 - 01.2013
Utilization Review/Coordinator ED
Community Regional Medical Center
03.2011 - 09.2011
Case Manager
SAMC
08.2010 - 08.2011
Staff Nurse
St Agnes Medical Center
08.2009 - 08.2010
Staff Nurse
Albany Medical Center
12.2006 - 07.2009
Nurse Extern -PCA (Patient Care Associate)
Albany Medical Center
06.2006 - 12.2006
Full time Clinical Instructor
STI
06.2005 - 04.2006
Part-time Clinical Instructor
University of Batangas
06.2004 - 06.2005
Part-time Clinical Instructor
Lyceum of Batangas
06.2002 - 06.2004
Staff Nurse
San Jose District Hospital
06.1993 - 03.2006
Master of Arts - Nursing
Golden Gate Colleges Graduate School
Bachelor of Science - Nursing
Lyceum of Batangas
Secondary Education -
St. Joseph Academy
Primary Education -
Aya Elementary School