Experience

JSA Healthcare Corporation, A DaVita Medical Group

• United States
• Hospitals and Health Care
• 100 - 200 Employee

• Case Manager

  • Aug 2015 - Present



IASIS Healthcare

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Nurse Case Manager/ Specialty Drug

  • May 2014 - Present

  Case/Disease Management-Specialty Pharmacy Act as a liaison to facilities, providers and/or members related to issues in case management and care services. Identify member needs and address these needs to remove any barriers in achieving optimal behavioral health and medical care. Educated members on the importance of good health and following up to the Primary Care Physician or Specialist on a regular basis. Request and review medical records. Provide member education on… Show more Case/Disease Management-Specialty Pharmacy Act as a liaison to facilities, providers and/or members related to issues in case management and care services. Identify member needs and address these needs to remove any barriers in achieving optimal behavioral health and medical care. Educated members on the importance of good health and following up to the Primary Care Physician or Specialist on a regular basis. Request and review medical records. Provide member education on disease processes. Develop and monitor the member’s care plan goals for progress and outcomes. Specialty Pharmacy Identify members through the daily inpatient census, who are readmit within the last thirty (30) days and/or have specific disease conditions, such as, HIV,HCV, RA CHF, COPD, DM. Coordinate with all providers involved in the treatment of members identified as needing assistance with managing chronic medical conditions. Notify the member’s Primary Care Physician and Specialist of admission and discharge from any inpatient setting to facilitate coordination of care. Monitor progress towards treatment goals.

• Managed Care UR Nurse

  • May 2014 - Jul 2015

  Provide admission and concurrent review on inpatient members. Ensure and facilitate quality and cost effective health care delivery. Review all inpatient admissions and initiates discharge planning in a timely manner. Utilize clinical skills, chart review, physician communication and Milliman for Criteria. Conduct ongoing review for members in inpatient stay and utilize peer review, as necessary. Complete onsite and/or telephonic admission and concurrent reviews for medical… Show more Provide admission and concurrent review on inpatient members. Ensure and facilitate quality and cost effective health care delivery. Review all inpatient admissions and initiates discharge planning in a timely manner. Utilize clinical skills, chart review, physician communication and Milliman for Criteria. Conduct ongoing review for members in inpatient stay and utilize peer review, as necessary. Complete onsite and/or telephonic admission and concurrent reviews for medical necessity. Communicate requests which do not meet criteria with UR Coordinator and Health Choice. Medical Director(s) for determination. Provide notification to facility of determination. Facilitate member’s transfers within contracted facilities for ongoing inpatient stays. Initiate interdepartmental coordination to ensure quality and timely care for members. Complete prior authorizations as needed for discharge planning. Monitor utilization of non-medically necessary services and redirect as needed.



Specialty Pharmacy Nursing Network

• United States
• Biotechnology Research
• 1 - 100 Employee

• Clinical Research Coordinator

  • Jun 2013 - Apr 2014

  Specialty Pharmacy Nursing Network (SPNN) Clinical Coordinator (Research & Infusion) Responsible for communicating with patients, clinicians and MD office staff to provide confirmation of SPNN services coordinated. Follow up of services provided to MD and SPNN customers. Review and approve all nursing documentation. Contact the patient to validate the start of care date, answer any questions the patient or caregiver may have relative to the therapy and ongoing treatment. Coordinate… Show more Specialty Pharmacy Nursing Network (SPNN) Clinical Coordinator (Research & Infusion) Responsible for communicating with patients, clinicians and MD office staff to provide confirmation of SPNN services coordinated. Follow up of services provided to MD and SPNN customers. Review and approve all nursing documentation. Contact the patient to validate the start of care date, answer any questions the patient or caregiver may have relative to the therapy and ongoing treatment. Coordinate with the pharmacy regarding delivery of drug and supplies for the start of care. Coordinate with the nurse/agency regarding date and time of scheduled visits. Communicate with the physician’s office regarding patient status and any questions or concerns prior to the start as well as on going. Ensure that all nursing documentation forms are provided to nurse/agency. Follow up on visits made with patients and assess patient satisfaction with service. Review and approve all nursing documentation. Maintain performance indicator of : Nursing Documentation received within 48 hours, from nurse/agency visit. Nursing documentation faxed to MDO and customers within 5 days of visit. Perform patient and customer surveys as needed. Clinical Research Coordinator Medical Research Network , Buckinghamshire,UK Clinical Trials Acute Kidney Injury (AKI), HCV, Psoriasis. Inform patients or caregivers about study aspects to be expected and procedures. Schedule subjects for appointments with home nurse trial support. Monitor study activities to ensure compliance with protocols and with all relevant local, federal, and state regulatory and institutional policies. Communicate with laboratories or investigators regarding laboratory findings.Arrange courier service for specimen pick up, equipment and supplies for home nurse clinical support and determine staff or equipment availability. Communicate with Clinical Coordinator and Principal Investigators regarding adverse event and site effect. Instruct nur Show less Specialty Pharmacy Nursing Network (SPNN) Clinical Coordinator (Research & Infusion) Responsible for communicating with patients, clinicians and MD office staff to provide confirmation of SPNN services coordinated. Follow up of services provided to MD and SPNN customers. Review and approve all nursing documentation. Contact the patient to validate the start of care date, answer any questions the patient or caregiver may have relative to the therapy and ongoing treatment. Coordinate… Show more Specialty Pharmacy Nursing Network (SPNN) Clinical Coordinator (Research & Infusion) Responsible for communicating with patients, clinicians and MD office staff to provide confirmation of SPNN services coordinated. Follow up of services provided to MD and SPNN customers. Review and approve all nursing documentation. Contact the patient to validate the start of care date, answer any questions the patient or caregiver may have relative to the therapy and ongoing treatment. Coordinate with the pharmacy regarding delivery of drug and supplies for the start of care. Coordinate with the nurse/agency regarding date and time of scheduled visits. Communicate with the physician’s office regarding patient status and any questions or concerns prior to the start as well as on going. Ensure that all nursing documentation forms are provided to nurse/agency. Follow up on visits made with patients and assess patient satisfaction with service. Review and approve all nursing documentation. Maintain performance indicator of : Nursing Documentation received within 48 hours, from nurse/agency visit. Nursing documentation faxed to MDO and customers within 5 days of visit. Perform patient and customer surveys as needed. Clinical Research Coordinator Medical Research Network , Buckinghamshire,UK Clinical Trials Acute Kidney Injury (AKI), HCV, Psoriasis. Inform patients or caregivers about study aspects to be expected and procedures. Schedule subjects for appointments with home nurse trial support. Monitor study activities to ensure compliance with protocols and with all relevant local, federal, and state regulatory and institutional policies. Communicate with laboratories or investigators regarding laboratory findings.Arrange courier service for specimen pick up, equipment and supplies for home nurse clinical support and determine staff or equipment availability. Communicate with Clinical Coordinator and Principal Investigators regarding adverse event and site effect. Instruct nur Show less



Simply Better Health/EQH Solution

• tmpa, fl

• Nurse/Case Manager

  • Sep 2012 - Mar 2013

  Receives/responds to incoming calls from referral sources/potential Medipass recipients, exchanges information to identify the Medipass recipients needs. . Holds all referrals until all information is verified as complete and the next steps are determined.Handles verification of all referrals funneled through Triage, verifying information, applying business rules and determining the next steps. Acts as a clinical resource to department care coordinators, providing expertise and clinical… Show more Receives/responds to incoming calls from referral sources/potential Medipass recipients, exchanges information to identify the Medipass recipients needs. . Holds all referrals until all information is verified as complete and the next steps are determined.Handles verification of all referrals funneled through Triage, verifying information, applying business rules and determining the next steps. Acts as a clinical resource to department care coordinators, providing expertise and clinical knowledge. Show less Receives/responds to incoming calls from referral sources/potential Medipass recipients, exchanges information to identify the Medipass recipients needs. . Holds all referrals until all information is verified as complete and the next steps are determined.Handles verification of all referrals funneled through Triage, verifying information, applying business rules and determining the next steps. Acts as a clinical resource to department care coordinators, providing expertise and clinical… Show more Receives/responds to incoming calls from referral sources/potential Medipass recipients, exchanges information to identify the Medipass recipients needs. . Holds all referrals until all information is verified as complete and the next steps are determined.Handles verification of all referrals funneled through Triage, verifying information, applying business rules and determining the next steps. Acts as a clinical resource to department care coordinators, providing expertise and clinical knowledge. Show less



Walgreens Infusion services

• St. Petersburg Fl

• Case Management/Nursing dept

  • May 2008 - Apr 2012

  Responsible for the overall management, direction, and compliance of the clinical services provided in accordance with the policies and procedures. Ability to communicate effectively with team members, patients, caregivers, physicians and referral sources. In charge of staffing, nurse scheduling, chart audit, triage new referrals, ON/Call. Ability to teach and train staff, patients,caregivers clinical services such as: IV pump, Enteral Pump, Cardiac Program. Responsible for the overall management, direction, and compliance of the clinical services provided in accordance with the policies and procedures. Ability to communicate effectively with team members, patients, caregivers, physicians and referral sources. In charge of staffing, nurse scheduling, chart audit, triage new referrals, ON/Call. Ability to teach and train staff, patients,caregivers clinical services such as: IV pump, Enteral Pump, Cardiac Program.



Cryo-Cell

• United States
• Biotechnology Research
• 1 - 100 Employee

• Manager Hispanic Marketing

  • Mar 2005 - Mar 2008

  Develop and execute strategies to increase the awareness of cord blood banking and Cryo-Cell within the Hispanic Community. Key materials are developed in Spanish including websites, enrollment forms, consumer collateral materials, newsletters and advertising. Organize booth materials and travel to expectant patents fairs n Florida, Puerto Rico, California, Chicago ad New York. Give interviews and offer educational stories on television, radio and in print. Marketing efforts resulted in… Show more Develop and execute strategies to increase the awareness of cord blood banking and Cryo-Cell within the Hispanic Community. Key materials are developed in Spanish including websites, enrollment forms, consumer collateral materials, newsletters and advertising. Organize booth materials and travel to expectant patents fairs n Florida, Puerto Rico, California, Chicago ad New York. Give interviews and offer educational stories on television, radio and in print. Marketing efforts resulted in exceeding established baselines in Florida and Puerto Rico by 50% and 300% respectively. Puerto Rico market rose from 11th in overall U.S. revenues to 3rd, despite lower average household income. These markets currently provide more than 25% of U.S. revenues for new enrollments.

• Clinical Coordinator

  • Feb 2002 - Mar 2008

  Educate expectants parents and family about cord blood banking; enroll parents in Cryo-Cell services; coordinate and schedule shipment of specimen collection kit and associate paperwork. Educate physicians, labor and delivery nurses and other caregivers on the procedure for specimen collection and transportation. Educate parents, physicians, labor and delivery nurses and other caregivers about cord blood stem cells. Serve as liaison between laboratory director, parents ad caregivers regarding… Show more Educate expectants parents and family about cord blood banking; enroll parents in Cryo-Cell services; coordinate and schedule shipment of specimen collection kit and associate paperwork. Educate physicians, labor and delivery nurses and other caregivers on the procedure for specimen collection and transportation. Educate parents, physicians, labor and delivery nurses and other caregivers about cord blood stem cells. Serve as liaison between laboratory director, parents ad caregivers regarding potential for use of specimen for a transplant procedure.