Manager Quality Assurance
Resume:
Amy Wong, RN, BSN, PHN
Rancho Palos Verdes, CA 90275
EDUCATION: Bachelor of Science Nursing; University of Southern California
Certificate of Public Health; University of Southern California
CERTIFICATION: Accredited Case Manager (ACM): hospital/health system
Care Manager Certified (CMC): chronic and long term
Certified Senior Advisor (CSA): long term estate planning
EXPERIENCE:
June 2010 –
May 2011 AltaMed Health Services – Los Angeles, CA
Complex Case Manager
Physician Medical Group with large volume of dual coverage seniors and members with chronic,
complex disabilities. Case Managed 60-85 members with complex and multiple co-morbidities
across the spectrum of health services (transitions of care). Goal of disease management &
minimizing frequent acute hospitalizations. Emphasis on prudent benefit utilization with
referrals to community resources, state funded programs as well as housing and
behavioral/mental health resources. Individualized Care Plan implementation (assessment,
planning, implementation of services and setting realistic goals) for self management. Strong
knowledge of Milliman & Robert Guidelines, NCQA as well as HEDIS measures. Collaborated
with multi-disciplinary team to coordinate medical care, mental health counseling and in home
support along with discharge planning, home health needs and DME referrals. Followed
member in acute setting as well as outpatient facilities.
January 2010 –
May 2010 HealthCare Partners – Torrance, South Bay Region 3
Inpatient Case Manager
Ensured member met criteria for admission as well as ongoing appropriateness utilizing SI/IS
guidelines. Strong discharge planning, benefit coverage, Medicare/HMO/POS criteria.
Identified barriers for discharge and collaborated with member/family/healthcare providers and
resources for smooth transition to lower level of care. Identified members benefitting from
hospice, chronic care clinics, support groups as well as disease management/education.
January 2006 –
January 2010 Senior Solutions Team, Inc. - Long Beach, CA
Care Manager
High Risk Case Manager for diverse population with multiple chronic diseases, gero-psych
issues, frequent hospital utilizers as well as those with long term disabilities, catastrophic
illnesses across multiple service lines. Assess, plan, coordinate and evaluate all care and consult
with internal and well as external providers for seamless coordination of care by monitoring
service delivery of care as well as appropriate utilization of health benefits and community
resources. Care Plan development with client, physician, family and interdisciplinary team.
Individualized care plan development utilizing self managed goals through an extensive
assessment process: physical, functional, medical, social, financial environmental, nutritional.
Strong knowledge of family dynamics, community resources, mental health issues, catastrophic
illnesses/injuries, palliative and end of life care. Well versed with admission criteria to care
settings as well as insurance coverage and benefits.
August 2005 -
March 2006 Mission Hospice (Pasadena, CA) - Part Time Hospice Case Manager
Consultation with patient’s prior to admission, coordinated admission process and ongoing case
management. Coordinated admission to hospice as well as sign on process and communication
with all physicians and IDT. Developed plan of care as well as re-certified clients in a timely
manner, supervised ancillary staff and triaged all care needs.
October 2001 –
January 2006 Country Villa Health Services – Long Beach, CA
Case Manager – Skilled Nursing, Rehab and Sub Acute Facility
Management of fast paced, high volume senior and HMO
population. Discharge Planner, Utilization Responsibilities and Interdisciplinary Team Leader.
Ongoing quality assurance for clinical management and sound discharge planning outcomes.
Implementation of Quality Assurance program to monitor utilization, outliers and patient
satisfaction. Mediated NOMNC appeals, grievances and quality of care issues as well as
supported and advocated for patient’s needs and benefit entitlement. Ensured proper education
for complex discharges and provided teaching and education for sub-acute patients to minimize
return ER visits and or hospitalizations.
May 1996 –
October 2001 Driftwood HealthCare Center (SNF) – Torrance, CA
Director of Case Management & Admissions
Census development and marketing of 99 bed Skilled Nursing and Rehabilitation facility.
Management of interdisciplinary team to identify appropriate utilization of services and to
provide medically necessary, efficient and timely care to meet care plan goals. Assisted team in
identifying barriers for patient to reach discharge goals and explored alternatives with staff,
patient and family for appropriate discharge plan. Secured contract with leading medical group
to be the primary Skilled Nursing Facility in the region and started case management/intensivist
program.
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