Vivian Tsang
Alameda
Summary
Dynamic Utilization Management Nurse with extensive experience at North East Medical Services, excelling in care coordination and discharge planning. Proven ability to optimize length of stay and ensure medical necessity compliance. Skilled in interdisciplinary collaboration and patient education, driving successful transitions of care and enhancing patient outcomes.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Utilization Management Nurse
North East Medical Services
05.2024 - Current
- Perform initial and concurrent inpatient utilization reviews using InterQual to determine medical necessity and appropriate level of care across inpatient, observation, outpatient, SNF, and inpatient rehabilitation settings.
- Apply the nursing process of assessment, planning, implementation, monitoring, and evaluation to support care coordination throughout hospitalization and transition back to the community.
- Review Treatment Authorization Requests (TARs) and treatment plans to ensure compliance with Medicare, Medi-Cal, and commercial payer guidelines.
- Collaborate with physicians, bedside nurses, social workers, and palliative care teams to facilitate safe, timely discharge planning and reduce avoidable length of stay.
- Coordinate transitions of care by arranging post-acute services, follow-up appointments, and community resources.
- Lead repatriation efforts and collaborate with MSO case management teams and PCPs to ensure continuity of care and appropriate resource utilization.
- Make complex clinical decisions regarding medical necessity; escalate to Medical Directors as appropriate.
- Provide guidance and support to UM Coordinators; assist with onboarding and training.
- Document case activity across multiple electronic systems including EPIC, MediTech, and Microsoft applications to support quality, compliance, and reporting requirements.
RN Laser Technician
SEV Laser Aesthetics
09.2023 - 04.2024
- Conducted patient assessments to determine treatment appropriateness and safety, applying clinical judgment and patient education.
- Maintained accurate clinical documentation and adherence to regulatory, infection control, and safety standards.
- Demonstrated time management, independent decision-making, and patient advocacy in a fast-paced outpatient setting.
Nurse Assessor
Vi at Palo Alto
12.2021 - 06.2022
- Conducted comprehensive admission and ongoing assessments to evaluate medical stability, care needs, and appropriate level of care.
- Identified changes in condition and escalated findings to providers and interdisciplinary team members.
- Collaborated with nursing, medical, and social services teams to address barriers impacting care progression and discharge readiness.
- Supported utilization management principles through accurate documentation and care coordination.
LVN Charge Nurse
Belmont Health Care Center
11.2020 - 11.2021
- Completed admission assessments and ongoing clinical evaluations for medically complex and geriatric patients.
- Coordinated care with interdisciplinary teams to support patient progression and discharge planning.
- Ensured documentation supported medical necessity, regulatory compliance, and continuity of care.
- Responded to emergent situations, prioritizing patient safety and effective use of resources.
Home Health Nurse
Care Indeed Home Health
11.2020 - 08.2021
- Provided skilled post-acute nursing care supporting transitions from inpatient and SNF settings to home.
- Assessed ongoing skilled needs and eligibility for home health services.
- Educated patients and caregivers on medications, chronic disease management, and escalation indicators.
- Coordinated with providers and community resources to address psychosocial and environmental barriers.
Education
Bachelors of Science - Nursing
Capella University
Minneapolis, MN07.2024
Associate Degree - Nursing
Galen College of Nursing
San Antonio, TX06.2023
Master - Public Health
Los Angeles Pacific University
Los Angeles, CA08.2021
Licensed Vocational Nursing -
Unitek College
San Francisco, CA10.2020
B.S. - Nutrition Science with Emphasis in Nutrition Biology
University of California, Davis
Davis, CA06.2016
Skills
- Inpatient Case Management
- Care Coordination
- Utilization Management
- Concurrent Review
- Medical Necessity
- Level-of-Care
- Discharge Planning
- Transition Management
- Length of Stay Optimization
- Medicare
- Medi-Cal
- Commercial Coverage
- DRGs
- ACOs
- Reimbursement Models
- Chronic Disease Care
- Geriatric Care
- Interdisciplinary Collaboration
- Patient Education
- Family Education
- Regulatory Compliance
- Clinical Documentation
Websites
Certification
- Registered Nurse, 07/27
- Basic Life Support for Healthcare Providers (BLS), 11/2027
References
- Merjo Roca, RN, BA, Nurse Manager at Zuckerberg San Francisco General Hospital, merjo.roca@sfdph.org, (510) 685 - 0318
- Sandra Szeto, RN, Charge Nurse at Zuckerberg San Francisco General Hospital, sandra.szeto@sfdph.org, (415) 206 - 6597
- Dr. Daniel Flores, DNP, RN, RN Clinical Instructor at Galen College of Nursing, dflores@galencollege.edu, (210) 535-1636
- Dr. Sarah Oroszo, DNP, MSN, MHA, RN, RN Clinical Instructor at Galen College of Nursing, sorozco@galencollege.edu, (210) 387-1581
Professional Memberships
Sigma Theta Tau International, Omega Gamma Chapter
Systems And Languages
EPIC, MediTech, InterQual, PointClickCare, EZ Suite, CareLink, Microsoft Office, English, fluent, Cantonese, fluent, Mandarin, basic
Timeline
Utilization Management Nurse
North East Medical Services
05.2024 - Current
RN Laser Technician
SEV Laser Aesthetics
09.2023 - 04.2024
Nurse Assessor
Vi at Palo Alto
12.2021 - 06.2022
LVN Charge Nurse
Belmont Health Care Center
11.2020 - 11.2021
Home Health Nurse
Care Indeed Home Health
11.2020 - 08.2021
Bachelors of Science - Nursing
Capella University
Associate Degree - Nursing
Galen College of Nursing
Master - Public Health
Los Angeles Pacific University
Licensed Vocational Nursing -
Unitek College
B.S. - Nutrition Science with Emphasis in Nutrition Biology
University of California, Davis