Ace Landicho

Conducted quality audits of clinical utilization management reviews ensuring compliance with client standards and workers' compensation regulatory guidelines; developed QA monitoring tools and provided feedback to improve review accuracy and operational performance.

Performed 10–25 utilization management case reviews daily using MCG and InterQual within Cerner PowerChart to determine medical necessity and appropriate admission status, escalating complex cases to physician advisors.

Provided bedside nursing care in a medical-surgical ward including medication administration, vital sign monitoring, patient assessment, and coordination with multidisciplinary teams to support patient outcomes.

Analyzed pharmacy benefit and drug utilization data for PBM clients, performed ICD-10 coding, conducted clinical drug claims analysis with RXClaims, and participated in QA and coder training to ensure coding and coverage accuracy.

Provided home nursing care for patients with stroke, lung cancer, COPD, and prostate cancer including medication administration, vital sign monitoring, rehabilitation support, and family education.

Managed claims reimbursement investigations and denial analysis using Navinet and payer systems to resolve billing issues and improve reimbursement outcomes.

Reviewed outpatient medical records and assigned ICD-10 codes based on clinical documentation while assisting trainees preparing for AAPC certification to improve coding accuracy.

Completed a Bachelor of Science in Nursing program covering clinical nursing practice and allied health coursework from 2006 to 2010.