Mari F.
Interim Director Quality, Risk Management at Kirby Bates Associates- Claim this Profile
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Portuguese Native or bilingual proficiency
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English Full professional proficiency
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Spanish Professional working proficiency
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Italian Professional working proficiency
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LinkedInAug, 2020- Nov, 2024 -
Critical Thinking
LinkedInAug, 2020- Nov, 2024 -
Strategic Thinking
LinkedInAug, 2020- Nov, 2024
Experience
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Kirby Bates Associates
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United States
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Staffing and Recruiting
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1 - 100 Employee
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Interim Director Quality, Risk Management
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Nov 2022 - Present
Interim Director Quality and Risk Management, 11/2022 – 12/2022 Hired to evaluate the entire hospital to complete a full assessment, conduct gap analysis, develop Executive Summary with all identified areas of opportunities leading departments to compliance. • Conducted a gap analysis of the Quality/Risk Management Department and make recommendations for improvement in processes. • Conducted a gap analysis of the hospital’s peer review process and make recommendations for improvement in processes by ensuring applicable Serious Safety Events receive proper clinical review, coordinated Peer Review with Medical Staff Director. • Increased awareness of safety events through participation in daily patient safety huddles and makes recommendations for risk mitigation activities to the hospital’s leadership team. • Responded to unplanned visits from CDPH and other regulatory agencies. • Composed corrective action responses in response to regulatory reports of deficiencies. • Designed a Fall Debrief Decision Tree, instruction and Fall Debrief tool for hospital to use. • Designed a Fall Debrief Decision Tree, instruction and Fall Debrief tool for hospital to use. • Designed Emergency Action Plan with instruction and Emergency Staffing Tree. • Designed a Fall Debriefing Tool with instructions and Fall Debrief Tree. • Analyzed and updated risk reduction strategies to assure safety and quality to patient care by creating action plans, emerging risk internal audits, DYAD rounds, and evaluating core measures improvements needed. • Conducted analysis of all 2022 department’s performance improvement plans and made recommendations for 2023 P.I. plans. • Facilitated the hospital’s Quality Committee to include organizing content for the meetings, composing meeting agendas and keeping meeting minutes. Organized and conducted the Third QAPI Committee Meeting. Show less
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B.E. Smith
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Northridge, California, United States
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Interim Director of Risk Management, Patient Safety
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Dec 2021 - May 2022
Dignity Health Northridge Hospital Medical Center a 300+ beds facility a part of CommonSpirit Health, large network serving Los Angeles and adjacent areas on emergency care, acute care, trauma center, cancer center, behavioral health, and maternity care. Interim Director Risk Management, Patient Safety Officer, 12/2021 – 03/2022 Hired to mentor and aide in transitioning the new permanent director on how to manage an entire risk management and patient safety department. • Coordinated action plans, chart reviews, PDSA, RCAs, FMEA, RTM report, claims report, emerging risk internal audits, core measure improvement, grievances, analysis of sentinel and significant patient safety events. • Evaluated policies & procedures, processes, and practices with standards for patient care. • Responsible for the day-to-day operations of all system-wide Risk Management, including overseeing patient safety across all facilities. • Coordinated the strategic development of risk management and High-Reliability Organization (HRO) programs that achieve proactive risk mitigation and operational efficiencies. • Assessed compliance with accreditation standards and regulations. Identified key accreditation, regulation and licensing issues and defined areas for improvement. • Actively participated and coordinated hospital committees as appropriate (PI, Patient Safety Round Table, Patient Safety Committee, Safety/EOC, Grievances, Credentials, etc.) as well as the daily safety huddle. Show less
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Risk Management Services
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Houston, Texas, United States
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Interim Risk Management Senior Consultant
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Jun 2018 - Dec 2021
Independent consulting firm serving integrated healthcare systems, physician practices and healthcare executives in operational effectiveness and regulatory compliance. Provided expertise in areas of development, implementation & management the organization’s Risk Management, insurance, operational performance, quality indicators, service line development. • Determined areas of emerging risks in the facility and develops appropriate risk mitigation • Conducted internal audits for identification of risk prevalence within the organizations. • Established, maintained, and implemented a multidisciplinary Performance Improvement; Risk Management and Medical Staff Development Program to promote ongoing patient safety, patient care outcomes according to organizational goals and standards. • Managed reactive & proactive risk reduction strategies to assure safety and quality to patient care and customers. • Reviewed and analyzed occurrence data, claims data, and other sources for risk related trends • Reviewed and recommended new or amended policies and procedures. • Accountable for ensuring risk identification strategies. • Facilitated root cause analysis of sentinel and significant patient safety events. • Evaluated policies & procedures, processes, and practices with standards for patient care. Show less
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UHS
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United States
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Hospitals and Health Care
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700 & Above Employee
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Interim Director Risk Management; Patient Safety Officer, Regulatory Compliance Officer, PI
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May 2021 - Aug 2021
Regional Behavioral Health facility serving Bradenton and adjacent areas on acute adolescent, adult and geriatric inpatients and Outpatients. • Second day of hire led Joint Commission to triennial accreditation. • Maintained a multidisciplinary Performance Improvement, Risk Management program to promote ongoing patient safety and patient care outcomes. • Reviewed and updated risk reduction strategies to assure safety and quality to patient care by creating and coordinating action plans, RCA, PI indicators, emerging risk internal audits, and evaluating core measures improvements needed. • Implemented the “Good Catch Program” to promote safety education on potential patient harm precautions and preventions. Show less
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Insurance Services
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Houston, Texas, United States
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Insurance Senior Consultant
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Sep 2018 - May 2021
Provide expertise in areas of management strategy to assuring all aspects of insurance and claims program services are developed, implemented, and monitored. • Determined compliance mechanisms for the completion, submission and maintenance of reports, records, and other information as required by regulatory agencies • Established efficient operations and structure to enhance quality of service, service line development, employee benefit program, Health Insurance engagement, employee’s recruitment/retention, and training for senior staff to support personnel and families. • Created unit/service-based account management program integrating insurance, claims and financial perspectives for cost-effective use of resources to enhance reimbursement by 35%. • Developed managed care operations including referrals and authorization, utilization management reporting, benefits analysis, denials / appeals and provision of education. • Assisted in identifying agency alignment with health care reform and value-based opportunities. • Developed a streamlined process for referrals and customer calls to enhance quality of care, timely response to customers and revenue growth. Show less
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Assurance Health System closed
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United States
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Hospitals and Health Care
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1 - 100 Employee
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Director of Quality, Risk Management & Compliance
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Feb 2018 - Apr 2019
Hired to design, develop, implement & manage the organization’s Quality Improvement, Patient Safety, Risk Management and regulatory compliance programs across the organization . • Provided expertise in areas of operational performance, Quality Indicators, Joint Commission start up preparedness, service line, policies & procedures development and implementation. • Recruited and interviewed Medical staff for first Texas location. • Identified Peer Review and Human Resources compliance improvement measures that needed to be addressed. • Educated leadership, medical staff, and employees on Lean standards, quality and safety Improvement plans and their respective responsibilities in carrying out the programs. • Ensured clinical competence of medical staff in developing and implementing process improvement initiatives through educating medical staff on Lean standards, regulations and survey processes. Show less
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Quality Management Coordinator (Manager)
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Apr 2016 - Oct 2017
Reported directly to CMO. Managed the medical staff’s Quality Performance Improvement program. Assessed clinical systems, processes and outcomes related to treatment provided by the medical staff.• Developed and implemented the first multi-specialty organizational Professional Practice Excellence Committee/PPEC with 30 members.• Partnered with CMO to review 900+ clinical medical record cases within the first year, significantly decreasing backlog by 85%.• Partnered with Intensive Care Unit/ICU Medical Department Chief to identify Quality Measures and Quality Indicators; through medical records reviewed, backlog decreased by 90%.• Prepared PPEC agenda and meeting, moderated meeting, followed up with medical staff Department Chief on committee case decisions.• Assisted Medical Affairs Director in 800+ medical staff performance and granted privileges evaluation, and reaccreditation using OPPE/Ongoing Professional Practice Excellence & FPPE/Focused Professional Practice Excellence.• Ensured clinical competence of all medical staff in developing and implementing process improvement initiatives; educated nursing staff on standards, regulations and survey process.• Reviewed PPEC medical record cases for Joint Commission accreditation survey, with exceptional results.• Improved communication and feedback of concerns between hospital departments; increased patient and peer complaint cases resolution score by 64%.• Designed and produced custom monthly and quarterly reports, pie charts; and excel graphics to PPEC Members.• Approached clinical cases with independent action, addressed issues proactively, engaged in problem solving and process improvement. Show less
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PAS Service Coordinator
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Sep 2015 - Mar 2016
Liaised with hospital departments; ensured communication and feedback of concerns, grievances were completed in a timely manner.• Improved communication and feedback of patient concerns as well as grievances of medical staff, increasing patient satisfaction scores by 55%.• Identified problem areas, created reports and facilitated improvements through trending• Conducted impatient & outpatient pre-certification Process Improvement for direct admit and other assigned accounts, decreasing time by 75%.• Reviewed satisfaction surveys for trends and quality initiatives, reported complaint investigations, coordinated grievance documentation in accordance with hospital policies & procedures.• Educated & cross-trained medical & nursing staff using a patient focused case management model. Show less
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LNC in office, independent contract
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Houston, Texas Area
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Legal Nurse Consultant
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Jul 2010 - Sep 2015
In house and independent consulting firm conducting legal research and clinical medical records review for multiple areas in class action litigations. • Generated a profit of $1,250,000 from successful closure of class action litigation projects including medical malpractice, personal injury, medical negligence & product liability projects. • Reviewed 1000+ clinical cases in six months, decreased clinical medical record review backlog by 70%. • Conducted legal research, completed production pace for reviewing, evaluating and summarizing litigation’s clinical medical records 10,000 pages a month, case assignments, and chronology summary. Decreased allocated time by 50%. • Produced an additional savings in reviewing, translating and evaluating projects from different languages into English, decreased backlog by 35%. Show less
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Health Care Services Houston
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Houston, Texas Area
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Quality Assurance Consulting, Nurse Coordination
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Jul 2010 - Sep 2015
Independent consulting firm serving integrated healthcare systems, acute care teaching, physician practices and healthcare executives in operational effectiveness and regulatory compliance. Provided expertise in areas of operational performance, quality indicators, Joint Commission preparedness, service line development, physician engagement, nurse recruitment/retention, and training for senior medical staff. • Trained medical staff on Operational Performance Improvement and 100+ staff nurses g in short, long term and acute care. • Ensured clinical competence of all staff, participated in developing and implementing process improvement initiatives and educated senior staff nurses on new standards, regulations and survey process. • Audited 1000+ charts, admission plan of care, summaries, discharge plans for clients. • Led MOCK surveys at the request of clients. • Evaluated clinical cases for completion for healthcare companies prior to state survey. • Implemented utilization review and case management programs per request of client companies. Show less
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State of Alaska – DHSS – SDS
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Anchorage, Alaska Area
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Health Program Manager II
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Aug 2009 - 2010
Provides medical and behavioral assistance to Alaskan citizens. • Reviewed and executed patient assessments. • Conducted OA/APD waiver. • Implemented PCA programs Provides medical and behavioral assistance to Alaskan citizens. • Reviewed and executed patient assessments. • Conducted OA/APD waiver. • Implemented PCA programs
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Hope Community Resources
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United States
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Individual and Family Services
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100 - 200 Employee
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Community Support Supervisor
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Aug 2008 - Sep 2009
Non-profit organization providing services throughout Alaska to people who experience intellectual and developmental disabilities, mental health challenges, and complex medical conditions. • Managed a team of 40 staff member. • Coordinated a group of Assisted Living Homes, Foster Care, and Independent Living Homes. • Assured compliance with licensing regulations. • Executed Plans of Care, Case Management, and Utilization Review. Non-profit organization providing services throughout Alaska to people who experience intellectual and developmental disabilities, mental health challenges, and complex medical conditions. • Managed a team of 40 staff member. • Coordinated a group of Assisted Living Homes, Foster Care, and Independent Living Homes. • Assured compliance with licensing regulations. • Executed Plans of Care, Case Management, and Utilization Review.
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Education
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1986 - 1991
Universidade Gama Filho
Bachelor's Degree, Nursing Medical Surgery, Obstetrics and Hospital Administration
Community
