ROSA ALMANZA
Menifee
Summary
Bilingual healthcare professional with over 20 years of experience, including 9 years in clinical auditing, quality assurance, case management, and utilization management. Expertise in leading interdisciplinary teams, optimizing care delivery, and applying data-driven strategies to enhance patient outcomes. Active LVN in California and Washington, skilled in staff training and healthcare administration. Committed to improving team performance and fostering supportive environments for optimal patient care.
Overview
21
21
years of professional experience
Work History
Nurse Supervisor Prior Auth
Altura Medical Groupd
Montebello
01.2026 - Current
- Supervised nursing staff to ensure compliance with care protocols and enhance patient outcomes.
- Managed scheduling to maximize nurse coverage during peak hours, improving patient care availability.
- Resolved conflicts among staff to maintain a positive work environment.
- Participated in budget preparation process to determine staffing needs for the unit.
- Worked closely with executives to administer operations, staff, resources and budget management.
- Conducted comprehensive reviews of patient medical records for accuracy and compliance.
- Educated nursing staff on best practices for clinical documentation and review processes.
Triage Nurse Afterhours
Astrana
Alhambra
04.2024 - Current
- Answered incoming patient calls, gathering history and symptoms to effectively assess medical complaints.
- Implemented triage protocols that enhanced patient flow during emergency situations.
- Trained new staff on triage processes and best practices, ensuring consistent patient assessment.
- Prioritized multiple tasks to accommodate urgent requests for assistance from the emergency department.
- Maintained up-to-date knowledge of current nursing practices and procedures through continuing education courses, workshops, in-services, seminars, conferences.
UM Manager
Optum
08.2022 - 12.2025
- Managed a team of 12 direct report nurses, overseeing their daily activities and performance.
- Provide supervision, expert clinical knowledge, and guidance to front line employees.
- Daily UM Authorization Approval/Denials using appropriate Hierarchy Criteria.
- Ensured consistent application of criteria and developed corrective action plans for deficiencies, applying clinical knowledge to guidelines for determining medical necessity.
- Developed and implemented tools to evaluate employee productivity against benchmark standards, initiating corrective interventions as needed.
- Identify and provide ongoing educational opportunities to staff, ensuring an understanding of business processes, technology, health care reform and the impact on both the department and the organization.
- Identified training and staff development opportunities based on productivity and quality standards achievement.
- Recruits staff, interviews, hires, and effectively on-board new department staff.
- Adjust workflow responsibilities in line with staff expertise and availability.
- Responsible to provide responses for CAPs audits from multiple Health plans.
- Presented at Office Manager's meetings.
On Site Inpatient Case Manager
Prime Care of Corona (OptumCare)
10.2018 - 08.2022
- Coordinated complex case management activities, enhancing comprehensive patient care through effective oversight and collaboration.
- Perform utilization and concurrent review of inpatient cases using internal Guidelines, CMS and Milliman Care Guidelines criteria.
- Processed UM authorization requests and denials, ensuring adherence to guidelines and facilitating timely access to care.
- Establish action plans based on case facts, best practices, protocols, jurisdictional issues & available resources.
- Identify and evaluate delays in care.
- Initiate a discharge plan and a readmission prevention plan.
- Approved DME, coordinated transitions of care, and arranged physical and occupational therapy, ensuring appropriate home care and hospice services based on medical necessity.
- Act as liaison between patient and care personnel to ensure that all necessary care is provided promptly and effectively.
- Initiate/Assist with Transfers to HLOC/Tertiary.
In Patient Case Manager
Regal/ADOC Medical Group
05.2017 - 10.2018
- On Site Inpatient Case Manager for Fountain Valley Regional and Orange Coast Memorial.
- Perform utilization and concurrent review of inpatient cases using Milliman Care Guidelines criteria.
- Identify and evaluate delays in care.
- Established action plans that addressed case facts, best practices, protocols, jurisdictional issues, and available resources.
- Liaised between patients and care personnel to ensure timely and effective delivery of necessary care.
- Initiated discharge and readmission prevention plans to enhance continuity of care.
- Oversaw complex care cases in the transitional care management program.
- Carry out investigations into the clinical needs of patients.
- Authorized DME, transitions of care, physical/occupational therapy, home care, and hospice based on medical need.
LVN II Population Manager Coordinator
KAISER PERMANENTE
01.2017 - 04.2017
LVN, Quality Coordinator (Seasonal)
APOLLO MED
01.2014 - 03.2017
- Coordinated care and trained healthcare professionals to enhance patient outcomes.
- Administered medications and treatments as prescribed by healthcare providers.
- Monitored patient vital signs and reported changes to the nursing team.
- Assisted in developing individualized care plans for diverse patient needs.
Lead Case Manager
APOLLO MED
01.2014 - 01.2017
- Supervised IPA case management nurses, ensuring effective daily operations.
- Reviewed financial records to ensure compliance with regulatory standards.
- Supported credentialing processes, facilitating timely approvals for healthcare providers.
Clinic Manager/LVN
ApolloMed Orthopedic and Primary Care Clinics
01.2013 - 01.2014
- Managed and supervised operations of 3 multi-physician clinics to ensure efficient patient care.
- Supported billing department by initiating claims and performing accurate data entry to streamline reimbursement processes.
- Managed daily clinic operations and ensured seamless patient flow.
- Supervised staff and provided training on best practices and protocols.
- Coordinated patient scheduling and optimized appointment management systems.
Medical Assistant Front/Back Office
Jamie C. Oey MD (Pediatrics)
01.2010 - 01.2013
Medical Assistant Front/Back Office
Kishore S. Tonsekar MD. (General Surgery)
01.2009 - 01.2010
Medical Assistant Front/Back Office
Cardio Medical Consultant Group (Cardiology)
01.2006 - 01.2009
Medical Assistant Front/Back Office
Renal Medical Group (Internal Medicine & Nephrology)
01.2005 - 01.2006
Education
LVN - Nursing
Stanbridge College
Irvine06.2014
Skills
- Utilization review
- Clinical supervision
- Nursing supervision
- Patient assessment
- Care coordination
- Quality control
- Utilization oversight
- Audit compliance
- Clinical records
- Documentation guidelines
- Schedule management
- Staff recruitment
- Team leadership
- Monitor compliance
- Conflict management
- Leadership skills
Languages
- Spanish
- English
Licensure Certification
- State License LVN, Current
- BLS Certification, Current
- IV Therapy and Blood withdrawal, Current
- Phlebotomy, Current
- Fire Safety, Current
- Medical Billing Certificate, Current
Languages
Spanish
Native/ Bilingual
English
Full Professional
Timeline
Nurse Supervisor Prior Auth
Altura Medical Groupd
01.2026 - Current
Triage Nurse Afterhours
Astrana
04.2024 - Current
UM Manager
Optum
08.2022 - 12.2025
On Site Inpatient Case Manager
Prime Care of Corona (OptumCare)
10.2018 - 08.2022
In Patient Case Manager
Regal/ADOC Medical Group
05.2017 - 10.2018
LVN II Population Manager Coordinator
KAISER PERMANENTE
01.2017 - 04.2017
LVN, Quality Coordinator (Seasonal)
APOLLO MED
01.2014 - 03.2017
Lead Case Manager
APOLLO MED
01.2014 - 01.2017
Clinic Manager/LVN
ApolloMed Orthopedic and Primary Care Clinics
01.2013 - 01.2014
Medical Assistant Front/Back Office
Jamie C. Oey MD (Pediatrics)
01.2010 - 01.2013
Medical Assistant Front/Back Office
Kishore S. Tonsekar MD. (General Surgery)
01.2009 - 01.2010
Medical Assistant Front/Back Office
Cardio Medical Consultant Group (Cardiology)
01.2006 - 01.2009
Medical Assistant Front/Back Office
Renal Medical Group (Internal Medicine & Nephrology)
01.2005 - 01.2006
LVN - Nursing
Stanbridge College