Praveen Gopal
Alappuzha, Kerala
Summary
Results-driven UM Nurse Consultant with a strong background in regulatory compliance and evidence-based evaluation. Expertise in patient care coordination and thorough medical documentation reviews to ensure quality outcomes.
Overview
11
11
years of professional experience
2
2
Certifications
Work History
UM Nurse Consultant
EXL Services
Kochi, Kerala
06.2023 - Current
- Completed day-to-day duties accurately and efficiently.
- Reviewed regulatory compliance to ensure adherence to healthcare standards.
- Perform utilization management reviews (pre-authorization, concurrent, retrospective) using
InterQual and Milliman guidelines. - Conduct detailed medical documentation reviews including physician notes, progress notes,
diagnostics, and discharge summaries. - Review and manage cases within electronic health record (EHR) systems ensuring data accuracy
and continuity of care. - Evaluate treatment plans against evidence-based guidelines and recommend appropriate
alternatives. - Collaborate with physicians, case managers, and care coordinators to support timely authorizations.
- Support denial prevention strategies and peer-to-peer review preparation.
Staff Nurse (TL), Medical Intensive Care Unit
Kenganar Hospital Multi speciality and Trauma Centre
Bangalore
10.2021 - 10.2022
- Managed multiple tasks simultaneously while maintaining quality standards of care.
- Demonstrated effective communication skills while interacting with patients, families, physicians and other healthcare staff members.
- Coordinated care with charge nurse and other staff through daily communication.
- Implemented infection control measures to reduce the spread of contagious diseases.
- Coordinated care with physicians and other clinical staff to prepare for treatment, carry out interventions, and enhance continuum of care.
- Evaluated the effectiveness of nursing interventions and modified plans as needed.
- Identified potential problems or issues that may arise during treatment, such as drug interactions or allergies, and provided appropriate interventions when necessary.
- Addressed rapid response and code situations by strategically organizing and delegating tasks.
- Actively participated in departmental meetings, training sessions and educational seminars.
Staff Nurse, Medical Intensive Care Unit
Wockhardt Hospitals
Nagpur
08.2014 - 09.2021
- Administered medications and treatments to critically ill patients.
- Collaborated with multidisciplinary teams to develop care plans.
- Assisted in advanced life support procedures during emergencies.
- Maintained accurate patient records using electronic health systems.
- Provided emotional support to patients and their families in high-stress situations.
- Ensured compliance with safety protocols and infection control measures.
- Conducted daily rounds with attending physician to discuss current status of all MICU patients.
- Collaborated with interdisciplinary team members to develop individualized patient plans of care.
Education
Bachelor of Science - Nursing
Sri Devi College Of Nursing
Tumkur, Karnataka01-2013
Higher Secondary -
Padanilam HSS
Noornad, Kerala03-2009
SSLC -
Padanilam HSS
Noornad, Kerala03-2007
Skills
- Utilization management
- Regulatory compliance
- Evidence-based evaluation
- Electronic health records
- Medical documentation
- Patient care coordination
- Time management
- Nursing informatics
- Case documentation
Certification
NCLEX RN, New Mexico, USA – 77888 on February 2024
Personal Info
- DOB : 15 October 1991
- Gender : Male
- Nationality: India
Timeline
UM Nurse Consultant
EXL Services
06.2023 - Current
Staff Nurse (TL), Medical Intensive Care Unit
Kenganar Hospital Multi speciality and Trauma Centre
10.2021 - 10.2022
Staff Nurse, Medical Intensive Care Unit
Wockhardt Hospitals
08.2014 - 09.2021
Bachelor of Science - Nursing
Sri Devi College Of Nursing
Higher Secondary -
Padanilam HSS
SSLC -
Padanilam HSS