JAMIE LEE RIVERA COTTO
Summary
Experienced Registered Nurse with over 17 years in healthcare, including 14 years in managed care and health insurance. Extensive background in medical utilization, pre-authorizations, discharge planning, and clinical auditing. Proven ability to collaborate across departments to optimize patient care and healthcare resource use. Known for strong analytical skills, efficiency, and ethical clinical judgment.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Pre Authorization Nuse
Humana
01.2017 - Current
- Performed medical utilization reviews and pre-authorizations for DME and other services
- Managed discharge planning and coordinated with providers and facilities
- Conducted medical record audits to ensure compliance and quality standards
- Supported operational improvements in managed care deliver
- Contact providers or facilities if additional clinical information is needed.
Communicate decisions to providers, case managers, or patients.
Coordinate with other departments like Case Management or Claims as needed.
Case Manager Nurse / Nurse Visitor
Triple-S
01.2011 - 01.2017
- Monitored high-utilization cases and developed individualized care plans
- Educated patients with chronic diseases and tracked clinical interventions
- Documented all clinical activity in EMR and prepared case reports
- Assisted in the development of disease management policies and objectives
Graduate Nurse RN, ICU
Doctors Center Bayamón
01.2009 - 01.2011
- Provided critical care nursing in ICU, OR, and surgical units
- Supported patients through complex procedures and recovery
Graduate Nurse RN
Hospital Pavia
01.2008 - 01.2009
- Rotated through ER, Nursery, NICU, and Medical-Surgical units
- Delivered compassionate and evidence-based patient care
Education
Master of Science in Nursing - Case Management & Admin
Universidad Ana G. Méndez
Bayamón05.2020
Pre-Medical Studies - undefined
Universidad Central Recinto Bayamón
Bayamón01.2016
Bachelor of Science in Nursing - undefined
Universidad Interamericana Recinto de Bayamón
Bayamón05.2008
Skills
- Medical Utilization Review
- Pre-authorizations (including DME and Prenatal)
- Discharge Planning
- Chronic Disease Case Management
- Medical Record Auditing
- Workflow Optimization
- Electronic Health Records (EHR)
- Team Collaboration & Communication
Certification
- CPR
- ACLS
- IV THERAPY
LANGUAGES
Spanish – Native
English – Intermediate (Conversational and Written)
References
Available upon request
Timeline
Pre Authorization Nuse
Humana
01.2017 - Current
Case Manager Nurse / Nurse Visitor
Triple-S
01.2011 - 01.2017
Graduate Nurse RN, ICU
Doctors Center Bayamón
01.2009 - 01.2011
Graduate Nurse RN
Hospital Pavia
01.2008 - 01.2009
Master of Science in Nursing - Case Management & Admin
Universidad Ana G. Méndez
Pre-Medical Studies - undefined
Universidad Central Recinto Bayamón
Bachelor of Science in Nursing - undefined
Universidad Interamericana Recinto de Bayamón
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