Diane Lopez-Castillo; BSN, RN, MSN, ARNP, CLL

*** ***** ******* ***** *********, Fl 33021 954-***-****

acr7ye@r.postjobfree.com

linkedin.com/pub/diane-lopez-castillo

Director/VP of HEDIS, Healthcare Quality Improvement; Care Management; Care Transitions

As a goal-driven professional in the health care industry for over 30 years, specialized training with a Master of Science in Nursing degree and ARNP licensure have contributed to success in health care administration, operations, regulatory compliance and quality improvement in various clinical settings. Career highlights include 10 years as administrator of inpatient/outpatient hospital behavioral health care services; 7 years as a Vice President of Quality in internal medicine hospitalist services; 2 years as Vice President of Health Services with health plan care management, transitions of care, NCQA criteria, HEDIS measures, STARS ratings; 5 years as AHCA Miami Field Office Manager with federal/state health care facility licensure and certification survey activities.

Professional Strengths: NCQA/HEDIS/STAR Ratings; Care Management; Care Transitions; Decreased Hospital Readmissions; Home Health; Operations Management; Balanced Budgeting; Quality Improvement Management; Performance Improvement Management; Client/Customer Satisfaction; Strategic Planning; Critical Thinking;

Psychiatric-Behavior Health Services; Lean (Green Belt); CMS/AHCA Regulatory Surveyor; Certified Laughter Leader; Effective Presentations;Training and Development

LICENSES:

- Advanced Registered Nurse Practitioner License (ARNP): State of Florida since 1981 with certification in Psychiatric-Mental Health Nursing

- Registered Nurse License (RN): State of Florida since 1977

EDUCATION:

- Master of Science in Nursing (Magna Cum Laude):University of Texas at Austin, 1979

Major: Psychiatric-Mental Health Nursing; Minor: Education with Cognate in Psychology

- Bachelor of Science in Nursing (Magna Cum Laude): University of Miami, Florida 1976

Major: Nursing Minor: Biology

EXPERIENCE:

Independent Living Systems; Miami, Florida

Vice President of Quality Health Services: Care Management & Care Transitions 4/2013 – 7/2015

Directed day-to-day operations of the Comprehensive Care Management- Special Needs Population Division, the Care Transitions-Post Acute Support Services (PASS) Division and Health Services Support Division; Coordinated and implemented care management and care transition programs for 6 health plans and 3 hospital community-based organizations; Supervised health plan clients’ clinical case management activities, utilization review and quality improvement support functions; developed and collaborated on 3 new and 9 existing clients’ contracts’ management, coordination and implementation of identified contract deliverables within negotiated timelines; Created workflows and metrics reporting to achieve compliance with all contractual/CMS-state requirements, quality improvement for all client CMS models of care.

Achievements:

• Successfully managed 90+ personnel (Directors, RNs, SWs, CCs) with operating budget of over $3 million; reduced staff turnover from 65% to 30% and increased staff job satisfaction from 70% to 87%.

• Achieved client (health plans, community based organizations) 90% compliance with contract expectations with increased documentation of HEDIS measures for 4 health plans and assisted with achievement of NCQA certification for 1 health plan.

• Increased STAR ratings from 4 stars to highest 5 stars rating for 2 health plans.

• Achieved reduction in hospital readmission rates from 24% to 12% in 2013 and down to 7% in 2014 (below the Hospital Compare 2015 national average 30-day readmission rate of 15%; 5-STAR rating requires less than 10%).

• Improved 1 health plan’s resource utilization management by reducing emergency department beneficiary usage from 60% to 48%, with cost savings of over $654,000.

• For 2 health plans, achieved 98% successful compliance with CMS, NCQA, HEDIS and STAR measures contractual audits/survey requirements in 2012, 2013 and 2014 with staff training, compliance metrics reports and IT software documentation enhancements.

• Saved 45 minutes/day of documentation activity and increased manager productivity by 50% with implemented streamlined online assessment and note documentation templates that captured all required NCQA and CM components for care managers and care transition managers.

TeamHealth Hospital Medicine & Florida Acute Care Specialists (FLACS); Sunrise, Florida 1/2007 - 4/2013

Vice-President of Quality (7/2011 - 4/2013)

Director of Quality (1/2007 - 6/2011)

As VP: Reviewed Hospital Medicine Division nationwide contractual performance expectations and provided analysis of current hospital and health plan compliance rates with contracts, Joint Commission and State quality and performance benchmarks; Developed quality and performance measurable metrics reports for contract sales/bonus structures with corrective action plans to make required/recommended improvements by hospitalists; Developed contract-specific HM Quality and Performance Orientation Manual that included health plan/hospital-specific dashboards and hospitalist bonus metrics on CMS Core Measures Compliance, HCAHPs Rates, 30-Day Readmission Rates, PCP/MD/Hospital Satisfaction Rates; Provided face2face HM Quality and Performance Orientation and on-going training to start-up health plan and facility contract hospitalists; Developed & implemented Documentation Template Tools that increased Case Mix Index, decreased Denials, increased Case Reimbursements; Provided on-going monthly tracking/trending reports on hospitalist-specific metric compliance and financial initiatives followed by hospitalist-tailored education, training and compliance accountability. As Director: Developed and implemented hospitalists training on FLACS-State of Florida Medicaid Contract performance expectations; Performed documentation tracking and trending with monthly/quarterly compliance reporting to the State Medicaid Department.

Achievements:

• Increased physician satisfaction rate from 70% to 89% after providing contract and quality required physician orientation and training monthly to: over 90 internal medicine hospitalists in Dade, Broward, Palm Beach counties in FL; 5 hospitalists in Philadelphia, PA; 4 hospitalists in Houston, TX; 10 hospitalists in Baton Rouge, LA; 2 hospitalists in Long Island, NY.

• Decreased average hospital 30-day readmission rate from 39% to 20% (below the 2012 national average rate 24%).

• Decreased hospital Payment Denial Rates from 76% to 45% by developing/training-on/implementing “Denials Management and Recovery Initiative” with medical records documentation review of severity of illness and intensity of service criteria.

• Increased Discharge Summary Timeliness/Content Dictation from 57% to 88% by developing/implementing a “Discharge Summary Content and Timeliness Documentation Initiative” for 5 health plans who required timely specific content dictation/documentation within 72 hours of patient discharge to be provided to patient PCPs; reviewed 150 hospitalist discharge summaries dictated each month for 2013 with direct feedback to each hospitalist and report card tracking of success.

• Achieved 0% target rate of hospitalists NOT ordering any of CMS’s “High-Risk Drugs in the Elderly” for which CMS would flunk the health plans if only 1 prescription was written for any of these drugs.

• Increased client/health plan/hospital satisfaction rates from 45% to 89% with improved hospitalist compliance with each health plan’s/hospital’s hospitalist requirements with on-going training, medical records review.

• As reported by health plans, increased Hospitalist to PCP communications after implementing Transition of Care-Next Level of Care Provider Communications process.

• Developed and distributed award-winning quarterly “FLACS Progress Notes Newsletter” to communicate updates/changes in health plan performance expectations, health plan contracted vendors, and hospitalist documentation do’s and don’ts.

Tender Care Home Health Services Corp., Davie, Florida

Director of Nursing/Professional Services 1/2006-10/2006

Developed/implemented administrative, clinical policies and procedures in compliance with state statutes, CMS federal regulations, CDC and OSHA guidelines for safety, standard precautions and infection control tracking and trending reports; Developed/implemented operational work-flows for increased efficiency of referral-admissions, staffing assignments, documentation/orders confirmation, quality audits of medical records, plan of care (PoC) coding/processing/billing, OASIS Start of

Care Reviews; Developed/implemented electronic Patient Evacuation-Emergency Management Patient Classification System; Developed/implemented job descriptions, position competencies and performance evaluations for all positions; conducted new-hire HHA Orientations; Coordinated patient care services as case manager (CM); completed CM case conference summaries and documented physician verbal-orders; Provided written responses to Additional Document Requests from Medicare, Denial of Payment Appeals, Administrative Law Judge Hearings, Medicaid Key-Pro; Performed home health visits as needed by staffing.

Achievements:

• Achieved successful Joint Commission accreditation and certification survey of home health agency with supervision of 10

office staff, 30 field staff consisting of RN, LPN, PT, OT, RD, MSW, HHAide, CNA.

• Developed/implemented on-going quality-performance improvement program with 25% improvement in Medicare OBQI core measures of performance.

• Decreased avoidable hospitalizations from 52% to 30% by implementing new tracking-trending system with staff education on quality improvement measures/home care behaviors as a participant in CMS-Medicare 8th Scope of Work Project on Improving Dyspnea.

State of Florida Agency for Health Care Administration (AHCA);

Miami, Florida 1/1999 – 12/2005

Field Office Manager (1/2001 - 12/2005)

Home Health/Hospital Division Supervisor (3/2000 - 12/2000)

RN SMQT Surveyor (1/1999 – 2/2000)

Responsibilities: As Field Office Manager, reorganized and hired qualified staff to ensure all required facility surveys were completed as required; reviewed required survey documentation and determined if minimum federal/state requirements were not met and placed consumers in immediate jeopardy; reviewed and responded to facility Corrective Action Plans of identified deficiencies and scheduled follow-up surveys to ensure corrective actions were in place; communicated with consumer complainants regarding identified facility failures to deliver required care and corrective actions implemented. As Supervisor, scheduled qualified surveyors to conduct hospital, home health agency and complaint surveys within CMS federal timelines and State of Florida statute requirements. As RN Surveyor, conducted and documented assigned federal and state licensure/certification nursing home, assisted living facility, hospital, home health agency surveys, Code 15 surveys and complaint investigations.

Achievements:

• Reorganized and supervised 50 employees consisting of 4 Supervisors, 4 Senior Clerks, 42 Health Care Facility Surveyors (RNs, RDs, SWs) with successful management of overall operating budget of $3,385,577 for Dade and Monroe Counties.

• Achieved 96% on-time successful completion of Dade and Monroe counties CMS federal certification, state licensure surveys and complaint investigations from a 5-year previous backlogged-workload of non-compliance with CMS federal timelines.

• Converted 90% RN Surveyor turnover rate and vacancy rate to 10% RN turnover rate by negotiating county-based salary increases based on market analysis of RN salaries.

OTHER EXPERIENCE:

- Director of Inpatient and Outpatient Psychiatric Services: Cedars Medical Center, Miami, Fl 1993-1998

- Clinical Specialist in Psychiatric-Behavioral/Mental Health: Mercy Hospital, Miami, Fl 1983-1993

- Psychiatric-Mental Health RN Team Leader: Coral Reef General Hospital, Miami, FL 1979-1983

- Psychiatric-Mental Health RN Staff Nurse: Highland Park General Hospital, Miami, FL 1976-1977

SKILLS:

- Languages: speak, read and write English and Spanish;

- Computer: created customer-defined screens/queries for Electronic Medical Record documentation; intermediate operational knowledge of MS Office Outlook, Word, Excel, PowerPoint, Lotus Notes, webex seminars;

- International public speaker on: “Stress Management” and “Laughter as the Best Stress Medicine”;

- Certified Laughter Leader (CLL) since 2005;

- “SMQT”- certified CMS Medicare Federal Regulations Surveyor/Inspector with Agency for Health Care Administration (AHCA) since 2000.

- Studer Trained in Customer/Client Satisfaction

- Lean Green Belt Training

- Professional Placement Network (PPN) Training

ACCOMPLISHMENTS/PROFESSIONAL MEMEBERSHIPS:

• Member of Phi Kappa Phi National Honor Society

• Member of Sigma Theta Tau International Honor Society of Nursing

• Member of World Laughter Tour Organization

• Awarded National Institute of Mental Health Psychiatric Fellowship

• Awarded Employee of the Month and Nurse of the Year

• Elected to Outstanding Young Women of America

• Elected to Who’s Who Among Students at American Colleges and Universities

• Published in Journal of Nursing Mana

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