Open to opportunities

Christabelle Pastor

@christabellepastor

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Utilization Management RN consultant skilled in outpatient medical necessity reviews and payer approvals.

Philippines

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What I'm looking for

I’m looking for a role where I can drive accurate outpatient utilization reviews—applying CPB/MCG for medical necessity, coordinating authorizations, and supporting cost-effective quality care in both clinical and administrative settings.

I’m a Registered Nurse focused on utilization management for outpatient care. In my current role as an UM Nurse Consultant, I perform concurrent, prospective, and retrospective reviews of outpatient medical records to assess medical necessity, appropriateness, and efficiency of care.

I apply CPB and MCG guidelines to determine compliance with evidence-based criteria for outpatient procedures, diagnostic testing, and therapies. I handle pre-authorization and pre-certification reviews for scheduled outpatient services, evaluate physician orders and treatment plans, and prepare clinical justifications and appeals for denied or pending services.

I’m also experienced across staff nurse, pediatric ward, emergency, and head nurse leadership—organizing and directing department functions, monitoring performance, and ensuring maintenance of medical records and confidentiality. I bring strong attention to detail, HIPAA compliance, and EMR documentation skills to support safe, timely, and cost-effective care.

Experience

Work history, roles, and key accomplishments

Current

UM Nurse Consultant

Current

EXL Service Philippines, Inc

Apr 2024 - Present (1 year 11 months)

Performed concurrent, prospective, and retrospective outpatient utilization reviews to assess medical necessity, appropriateness, and efficiency of care. Applied MCG/CPB guidelines to support pre-authorization and certification of outpatient services in EMR.

Utilization Management Outpatient Chart Review Clinical Appeals HIPAA compliance Service Utilization Monitoring

Head Nurse, Emergency Dept

Unihealth Southwoods Hospital

Mar 2016 - Sep 2021 (5 years 6 months)

Organized and directed department functions across emergency and general nursing units, interpreting and implementing established policies and guidelines. Evaluated area performance, supported service improvements, and ensured maintenance of medical records.

Policy Implementation Medical Records Management Confidentiality HIPAA compliance Service Improvement

Senior Nurse, NICU

Westlake Medical Center

Nov 2013 - Jun 2014 (7 months)

Monitored and documented NICU patient activity and supported clinical procedures alongside physicians. Maintained organized records and provided patient-family support throughout care delivery.

Patient Monitoring Clinical Documentation Procedural Support Clinical safety Customer Service

Staff Nurse, General Nursing Unit

Marian Hospital

Jan 2012 - Sep 2013 (1 year 8 months)

Provided direct patient care on the general nursing unit, including individualized assessments, treatments as ordered, and shift-to-shift reporting. Maintained accurate documentation and ensured confidentiality and HIPAA-compliant handling of patient information.

Clinical Documentation HIPAA compliance Patient Safety Confidentiality Care Coordination Medical Records Management

Senior Nurse, NICU

Westlake Medical Center

Jun 2006 - Jul 2011 (5 years 1 month)

Monitored and documented NICU patient activity, assisting physicians during deliveries and clinical procedures. Provided patient and family support with strong documentation and customer service practices.

Patient Monitoring Clinical Documentation Customer Service