NAPOLEON A. SEDANO

License Vocational Nurse

Microsoft Certified Professional (Windows NT December 2000)

Nortel Certified Professional (December 2000)

*** ******* **. ***. *

Glendale CA 91206

Tel : 818-***-****

Email: acrd4x@r.postjobfree.com

OBJECTIVE

To obtain an Employment in a progressive institution that will provide opportunity for career growth and skills enhancement.

SUMMARY OF SKILLS

Experienced with providing quality patient care, responsible, punctual, and reliable, organized, strong interpersonal and communicating skills, able to adapt and learn quickly, can handle queries very well in a professional manner, can work independently as well as in teams;

Computer Proficiency: Microsoft Office, Technical Support Skills

Bilingual: Tagalog/English; Current BLS card

WORK EXPERIENCE

April 2014 – August 2015 Network Medical Management, Alhambra CA

Position: Ambulatory Case Manager

1.Performs telephonic member assessment to determine if criteria met for enrollment into case management program. Conducts comprehensive initial Health Risk Assessment to identify member specific problems. Conducts initial assessment of members’ health status including condition-specific issues, documentation of clinical history, including medications. Initial assessment of activities of daily living (ADL), initial assessment of mental health status, including cognitive functioning, initial assessment of life planning activities, evaluation of cultural and linguistic needs, preferences or limitations, evaluation of caregiver resources, evaluation of available benefits. Development of a case management plan, including long and short-term goals, identification of barriers to meeting goals or complying with the plan, development of a schedule for follow-up and communication with the member. Development and communication of self- management plans for members. Communicates collaboratively with all healthcare professionals involved in the members care to achieve expected outcome. Generates referrals to contracted ancillary service providers and community agencies in collaboration with the member’s attending/primary care physician. Communicates with patients, their families or support systems, physicians and ancillary service providers to coordinate care activities. Arranges and participates in multi-disciplinary patient care conferences. Monitor, document, and report pertinent clinical criteria as established per UM policy and procedure. Performs other duties be assigned.

2.Process Transplant request by the provider such as Minor and Major Transplant cases from transplant evaluation to actual transplantation. Review cases and authorize or forward to medical director if case requires higher management decision.

Software: EZCAP, MS Office 2010

September 2012 – 04/01/2014 Molina Healthcare, Long Beach, CA

Position: Care Review Clinician 1

1.Involved in Discharge Planning for Los Angeles county.

-Work with case managers of different hospitals for discharge needs such as home health, skilled nursing facilities to make sure patients are place.

-Work with pharmaceutical companies about IV infusion and others as discharge requirements and give authorizations as per case manager’s approval.

-prepares ADHOC request as preparation for Letter of Agreement if the facility or company who will provide the services are not contracted.

-creates and provides authorization to SNF, Home Health, IV infusion, Transportation etc.

2.Utilization Management prior authorization for LA county.

-Process request from UMK2 centralize fax system, to authorization creation using QNXT software, to annotation up to outgoing fax to providers. Community Base Adult Services (CBAS) qualification and authorization of services. Process CBAS center request for face to face, review and re-authorization. Process the request using UMK2 centralize fax system to authorization creation using QNXT software, annotation and sending the authorization to requesting party.

Software: QNXT, UMK2, Interqual, MS Office 2010

Glendale Career College, Glendale, CA 11/2010-04/2012

Licensed Vocational Nursing Program

Florence Nightingale Award

Rizal Technological University, Boni Ave. Mandaluyong City, Philippines 10/1989 – Graduate

Bachelor of Science in Computer Engineering

REFERENCE:

Available upon Request

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