Mary Carol Ramos Page * of *

Mary Carol Ramos, Ph.D., R.N.- B.C,

C.P.H.Q., C.P.U.M., C.M.A.C., C.C.M.

***** *** *******

San Antonio, Texas 78259

Home 210-***-****

Qualification Highlights

$ Specialized expertise in health care education, clinical practice standards, clinical management,

quality management, case management, program design and development, utilization

management, risk management, infection control, and research-based practice improvement

$ Comprehensive education and experience in health care research, including research design,

implementation, research ethics, qualitative analysis, statistical analysis, survey and instrument

design and psychometrics

$ Extensive experience in Military Healthcare Delivery systems, including Case Management,

Development and Implementation of Clinical Practice Guidelines, Population Health, and

Seamless Transition between Military and VA delivery systems

$ Analysis of available healthcare outcomes data for analysis and process improvement planning

$ Utilization of Electronic Patient Record systems in capturing healthcare outcomes data

$ Expertise in regulatory agency interface, including JCAHO, OSHA, NCQA/HEDIS, HCFA, HIPAA

(Privacy Rules and Regulations, Administrative Simplification and Coding), ICD

$ Experience in complex project management, focused health care education, strategic planning

and market research in care delivery

$ Appreciation of the role of health care legislation and policy in the delivery of high quality patient

care

$ Familiarity with application for research funding and grantsmanship. Success in obtaining NCI

funding for multiyear, multi-millions dollar federal cancer project

$ Certification in healthcare quality (current), utilization management, case management

administration, and past certifications in nursing administration and managed care

$ Broad experience in managed care, both direct care and payor settings

$ Experience in data base building and data mining to support administrative decision making

$ Thorough understanding of health care information systems, coding and utilization of financial,

encounter, and coded data to support health care quality improvement decision making

$ Experience in health care risk management activities and policy-making

$ Excellent oral and written communication skills with broad experience in professional publication

and presentation

$ Investment in working with individuals at all organizational levels

$ Strong computer skills; experienced using PC-based (Microsoft) office software, including

spreadsheet analysis, word processing, presentation, database software, publication software,

PC-based statistical analysis software, SQL

Mary Carol Ramos Page 2 of 6

Work Experience

University of Texas Health Science Center San Antonio 2010 - Present

School of Nursing

Department of Health Restoration and Care Systems Management

Adjunct Faculty

United States Department of Veterans Affairs

Central Office, Washington D.C.

Federal Recovery Coordinator 2008 – Present

• Lifetime care coordination for most seriously wounded, ill, and injured Service Members and

Veterans

• Coordination of health care and benefits services between Department of Defense and

Department of Veterans Affairs

• Development of Care Coordination management software and data bases

• Development of Care Coordination Policies, Procedures

United States Army Medical Command

Quality Management Division, Evidence-based Practice Branch

Medical Management and Clinical Practice Guidelines Coordinator 2005 – 2008

• Leadership across US Army in transition to unified Medical Management system from

isolated Case Management, Disease Management, and Utilization Management

• Service on OTSG-level committees for planning patient- and family-centered health care

initiatives

• Service in Triservice/VA case management redesign bodies

• Faculty on TMA (Triservice) Medical Management Teaching efforts

• Coordination of Population Health outcomes quality initiatives across the U.S. Army Medical

Command

• Coordination of development, implementation, and evaluation of evidence-based Clinical

Practice Guidelines. Current coordination of behavioral health, pain control, PTSD, and post-

deployment health CPGs

• Coordination of purchasing and inventory control for warehouse systems in dispersal of

educational materials in support of CPGs

• Support of DoD-level policies and procedure development concerning Case Management

and evidence-based practice

• Budget management for Evidence-based Practice Branch

University of Texas Health Science Center San Antonio

San Antonio Cancer Institute

Cancer Prevention and Population Science Program Coordinator 2004 – 2005

• Development and implementation of community-based cancer support resources for

population in central south Texas

• Support of grant writing for funding of NCI-designated Cancer Center

• Grant writing (NCI) to develop support for community-based programs for disenfranchised

populations

Mary Carol Ramos Page 3 of 6

Work Experience (cont)

Joint Commission

Field Representative (50%) 2003 – 2004

Nurse Surveyor, HAP

Christus Santa Rosa Children’s Hospital, San Antonio, Texas

Quality Management Coordinator 2003 – 2004

• Quality Management Pediatric Hospital

Staff Nurse 2002 - 2003

Pediatric Hematology and Oncology

• Clinical practice in pediatric hematology, oncology, palliative care, and general pediatrics

• Committee representative to quality and pain management task forces

Graduate Nursing Program Faculty

University of Phoenix Online 2002 - 2006

Online instruction: Master’s level nursing research sections

Director, Case Management and Quality 2000 - 2001

Las Palmas Medical Center, El Paso, Texas

200-bed for-profit medical center in underserved border community. High proportion uninsured with complex

chronic illness and complicated discharge needs

• Design and implementation of Performance Improvement, design and implementation of Case

Management Program with Utilization Management, Denials Management components, HIPAA

Compliance with extensive staff education program design and implementation

• Coordination of JCAHO survey with extensive staff education program design and implementation

• Interface with Risk Management, legal implications of practice and patient safety initiatives

•

Corporate Director, Medical Management 2000

Schaller Anderson Inc, Phoenix, Arizona

Owners and administrators for five managed care plans, four Medicaid, in five states. Approximately

150,000 covered lives with claims administration and administrative functions centered in Phoenix.

• Supervision of prior authorization for two plans and after-hours customer service for all plans

• Coordination of HEDIS survey and staff education for three Medicaid plans in three states

• Coordination of disease management plans across plans

• Coordination of utilization management and quality management functions across plans

•

Mary Carol Ramos Page 4 of 6

Work Experience (cont)

Director, Clinical Resource Management, 1998 – 1999

Phoenix Children’s Hospital, Phoenix, Arizona

Arizona’s only independent pediatric facility, within Good Samaritan Regional Medical Center. Ninety-five

hundred admissions in 1998, 35,000 outpatient visits. Primary, tertiary, and quaternary, care in 74 general

pediatric beds, 18 biobehavioral beds, 92 nursery, 14 subacute, and 21 intensive care beds. Young

organization in transition to freestanding status.

• Implementation, support and management of case management services

• Supervision of Admissions office processes and personnel

• Oversight of regulatory interface including coordination of JCAHO survey and staff education

• Design of integrated utilization/denials management programs

• Design, implementation of case management outcomes measures

• Coordination of quality management and case management functions and staff education

• Analysis and redesign of process for writing, revision, and implementation of administrative and health

care policies and procedures

• Development of policies and quality-risk management interface with legal services

Director, Case Management 1997 - 1998

St. Francis Hospital, Columbus, Georgia

General Community hospital serving western Georgia and eastern Alabama. Emphasis on cardiovascular

services. Two hundred beds, no obstetrical services. High occupancy, brisk patient turnover, predominantly

Medicare population.

• Design and implementation interdisciplinary case management program: Integration of case

management, social work, and utilization review with concomitant staff education

• JCAHO survey preparation team

• Interaction and coordination of quality and risk management activities

University of Virginia, Charlottesville VA 1992 - 1997

Analyst, Regional Primary Care 1996 - 1997

Start-up unit for integration and support of 18 newly acquired primary care practices

• Compilation, analysis, and distribution of productivity, profitability, patient satisfaction, and wellness

documentation data

• Development of instrumentation and data-handling system for patient satisfaction data

• HEDIS education

• Collection and analysis of multiplier effect data

• Validity testing of RVU data

• Credentialing of health care professionals

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Work Experience (cont)

Clinical Analyst (University of Virginia, cont) 1994 - 1996

• Coordination of clinical staff and administrative clinical resource management (quality, risk)

• Research support for clinical and administrative decision-making for upper management

• Led efforts in Clinical Practice Improvement, enhancement of clinical quality systems, clinical practice

guidelines, and clinical pathway facilitation and implementation

• Clinical education concerning coding, documentation, applicability of clinical and financial data in

decreasing costs and length of inpatient stay while maintaining or improving clinical quality

• Project management for strategic planning, reorganization of clinical services within architectural and

construction planning

• Participation in Medicaid capitation proposal

Quality Management Coordinator 1992 - 1994

• Administration and support for quality improvement activities for 17 clinical departments

• Design and implementation of quality improvement plans

• Participation and coordination of risk management activities, case-finding, and data analysis

•

• Staff Nurse 1991 – 1992

• Charter Hospital of Charlottesville

• Renewal of clinical skills in mental health and psychiatric nursing

•

• Staff Nurse 1991

Medical Intensive Care Unit

University of Virginia Health Sciences Center

• Renewal of clinical skills in medical critical care

Graduate Instructor 1987 – 1989

University of Virginia School of Nursing

Charlottesville, Virginia

• Taught classes in graduate psychiatric nursing, graduate research methods, undergraduate

research, undergraduate clinical laboratory

• Research Center Associate assisting with grant applications and research administration

• Assisted with NLN survey preparation

Mary Carol Ramos Page 6 of 6

Education & Training

Degrees

Ph.D., Psychosocial Nursing and Research, 1990; University of Virginia, Charlottesville, VA

M.S.N., Psychiatric and Mental Health Nursing, 1988; University of Virginia, Charlottesville, VA

M.S., Community Psychology, 1984; Lamar University, Beaumont, Texas

B.S.N., 1975; University of Texas Medical Branch, Galveston, Texas

Diploma, 1969; Bronson Methodist Hospital School of Nursing, Kalamazoo, Michigan

Training Courses

Guided Care Nursing (Johns Hopkins)

Ongoing Comprehensive Training in VA Benefits

JCAHO New Surveyor Education

Coursework in Health Care Quality

Intermountain Health Care 1500 Hour Course in Health Care Quality Improvement 1994

Certification Course in Health Care Utilization Management

Coursework in Managed Care Management and Health Care Finance

Coursework in Health Care Administration

Course work in Regulatory Agencies, including JCAHO and HCFA

Certifications & Professional Affiliations

Board Certified in Case Management (RN-BC, ANCC)

Certified Case Manager (CCM)

Certified Professional in Healthcare Quality (CPHQ)

Certified Professional in Utilization Management (CPUM)

Certified Case Management Administrator (CMAC)

Certified Nursing Administrator (ANCC) expired

Professional, Academy for Healthcare Management

American Association for the History of Nursing

American Nurses Association

Association for Healthcare Risk Management

Association for Practitioners of Infection Control

Association of Pediatric Oncology Nurses

National Association for Healthcare Quality

Texas Association for Healthcare Quality

Texas Nurses Association

Honors & Awards

Phyllis J. Verhonick Nursing Research Award, 1991

Publications and Presentations Available Upon Request

Contact this candidate