RN Manager Clinical Operations Manager
Resume:
Rebecca Ortiz
RN, B.S.N, Case Manager, Nurse Management/Supervisor,Nurse Manager, Supervisor Team
Leader ship. Direct Care Nurse, Patient and Family Educatiion
San Antonio, TX 78251
ac0u47@r.postjobfree.com(210) 600-4077 Home
210-***-**** Cell
I find great deal of self satisfaction helping patients of all areas of the spectrum live a great quality of Life.And am also authorized to work for any US employer.
WORK EXPERIENCE
Merida Healthcare and Hospice
Visit Nurse Admissions Nurse, Treatment Nurse, Direct care nurse December 28,2016-January 23, 2017
SYNERGISTICS, Healthcare Industry Agency AUGUST 2016-PRESENT
Direct Care Nursing
THE JUDGE GROUP, Healthcare Industry Agency AUGUST 2015-SEPTMBER 2015
San Antonio, TX
R.N., BSN Preauthorization Nurse, PAN
Pre Authorization Registered /CM
• Exudes basic principles and practices of clinical nursing, experienced in all areas Case Management and Utilization Review.
• Familiar with NCQA and URAC Guidelines
• Medicare and Medicaid subject matter expert
• Extensive experience within a Health Plan Setting, Hospital, LTAC, Skilled Nursing Facilities.
• in PC Software, MS Word, Outlook, comfortable with technology
• Fluent in Spanish and English, telephonic Review
• Seasoned Registered Nurse with the ability to use logical reasoning for both simple and Experience with Electronic Medical Records
• Proficient complex decision making skills and problem solving skills.
Texas Army National Guard November 1987 to July 2013
San Antonio, TX
Major, Officer in Charge of Clinic Operations, Case Manager
• Managed the operations of numerous physicians and dentists, dental technicians, over 30 Paramedic/ EMT's and nurses inclusive of administrative support staff.
• Coordinate/manage medical services, involved providing free medical to the indigent patients living on the Texas/Mexican border.
• Evaluated work performances, provided counseling statements and awarded and promoted soldiers.
• Selected by command to join a task force to establish a case management to assist our uniform members returning from overseas and homeland missions in accessing benefits after incurring injuries after returning from their missions.
• "Texas Med Hold'em" arranged medical care; follow up appointments, reviewed referrals for medical necessity along with precertification of procedures, concurrent review for length of stay and retrospective review for those members already discharged.
• Arranged for discharge planning and transfers to lower level of care while ensuring quality care and maintain cost containment.
Aetna Us Healthcare/Ethix Southwest/NYLCare November 1994 to July 2000
San Antonio, TX February 2008 to July 2008
Case Manager/Clinical Evaluator/Officer in Charge of clinic operations
• Established/Maintained and immaculate record of performance in assessing, planning, implementing, coordinating, monitoring, and evaluating options and service as well as discharging planning and referral authorization for HMO,PPO,POS and EPO members.
• Managed cases for commercial insurance. Occupational health/worker’s compensation in this Long Term Acute Care Hospital setting. Interqual IS/SI and Milliman literate.
• Conducted bilingual presentations and coordinated with physicians, nursing staff, hospital administration, delegated groups, and family members.
• Utilized a comprehensive knowledge of HMO, PPO, POS, and EPO benefit provisions, population exceptions, and management.
• Coordinated with attending physicians, delegated group Case Managers, and referral processors to ensure quality and cost-effective patient care.
• Arranged for discharge planning and transfers to lower level of care while ensuring quality care and maintain cost containment.
• Performed early identification of continuing care needs to facilitate discharge to appropriate setting and handled discharge planning and coordination.
• Provided proactive and predictive identification as well as appropriate recommendations for referrals to alternative healthcare program disease management, and case management.
• Served as a subject Matter, Expert/Trainer for other company departments, (i.e.; Administration, Claims Processing, Customer Service, Marketing and Public Relations) on medical and benefit issues.
Kindred Hospital June 2007 to September 2007
San Antonio, TX
Case Manager II/Hospital Case Manager
• Managed cases for commercial insurance and occupational health/worker's compensation in this Long Term Acute Care Hospital setting.
• Conducted bilingual presentations and coordinated with physicians, nursing staff, hospital administration, delegated groups, and family members.
• Utilized a comprehensive knowledge of HMO, PPO, POS, and EPO benefit provisions, population exceptions, and management.
• Coordinated with attending physicians, delegated group Case Managers, and referral processors to ensure quality and cost-effective patient care.
• Performed early identification of continuing care needs to facilitate discharge to appropriate setting and handled discharge planning and coordination.
• Provided proactive and predictive identification as well as appropriate recommendations for referrals to alternative healthcare program disease management, and case management.
Case Manager/Clinical Evaluator
Well Med Medical Management December 2005 to January 2007
San Antonio, TX
-
Established/Maintained and immaculate record of performance in assessing, planning, implementing, coordinating, monitoring, and evaluating options and service as well as discharging planning and referral authorization for HMO, PPO, POS and EPO members.
• Managed cases for commercial insurance. Occupational health/worker's compensation in this Long Term Acute Care Hospital setting. Interqual IS/SI and Milliman literate.
• Conducted bilingual presentations and coordinated with physicians, nursing staff, hospital administration, delegated groups, and family members.
• Utilized a comprehensive knowledge of HMO, PPO, POS, and EPO benefit provisions, population exceptions, and management.
• Coordinated with attending physicians, delegated group Case Managers, and referral processors to ensure quality and cost-effective patient care.
• Performed early identification of continuing care needs to facilitate discharge to appropriate setting and handled discharge planning and coordination.
• Provided proactive and predictive identification as well as appropriate recommendations for referrals to alternative healthcare program disease management, and case management.
• Served as a subject Matter, Expert/Trainer for other company departments, (i.e.; Administration, Claims Processing, Customer Service, Marketing and Public Relations) on medical and benefit issues.
Occupational Health Nurse
Christus Santa Rosa Healthcare June 2003 to July 2005
San Antonio, TX
Multifaceted functions included administering immunizations, pre-employment health screenings, and Tuberculosis Surveillance of a campus of over 3000 employees.
• Worked closely with the Infection Control Department, Health Department, and Center of Disease Control to ensure timely reporting of communicable disease exposure.
• Functioned as Project Manager for the Fit City Bexar County Collaborative Walk San Antonio Program, Instrumental in the adaptation of changing of the snacks in the vending machines throughout the hospital with healthier snack selections.
• Planning and implementation of the Sharps Safety Program and Emergency Disaster Preparedness.
• Case Manager for on the job injuries, investigations, and payment.
• Ensured compliance with OSHA and JACHO guidelines for the Occupational Health Department and Infection Control.
• Designed and implemented an effective Annual Influenza Program.
Nursing Supervisor
Humana Health Care Plans, Clinic 1994 to 1995
San Antonio, TX
Office Manager Administrator
Flashner Medical Partnership 1990 to 1994
Deer Park, NY
• Effectively managed daily operations clinic, vital signs, patient education.
• Managed 40+ Personnel
• Staffing evaluation and counseling and promotions.
• Four of the six assistants became managers of their own clinic centers while under my supervision.
Staff Nurse
Flashner Medical Partnership 1990 to 1991
Hauppauge, NY
Responsibilities
Staff Nurse, VS, IV Insertions and infusions for pediatric patients and adults as well, Dsg Changes, charting
Accomplishments
Promoted to Office Administrator Responsible for daily operations of the facility, Became Trainer /Mentor for up and coming administrators. Selected “Office of the Year” for 4 consecutive years for "Commitment to Excellence”. Four of the Six Nurses I mentored received offices of their own.
Skills Used
Excellent Leadership Skillls
Med-Surg Staff Nurse
Good Samaritan Hospital 1988 to 1990
West Islip, NY
Honors, Award and Accolades
*Recipient, Awarded and Published in the International Nursing Association, Leaders in Healthcare 2015, Journal.
*Recipient of the 2014 Top Nursing Leader in America's Top Leaders of Healthcare Network, in
Nursing Magazine.
*Received Commitment of Excellence Award at Humana Health Care Plans, 1994.
*Recognized for becoming the "Office of the Month" six times.
*Four out of the six nurses I "Mentored", became Office administrators/ Managers and received
their own Urgent Care Clinics throughout New York.
Pediatric Student Externship/Graduate Nurse
Pediatrics/ PICU, Beth Israel Medical Center 1986 to 1990
New York, NY
Pediatric Graduate Nurse, Passed NCLEX, Worked Peds, Med Surg, Peds ICU, IV infusion of Lipids, Chemo and blood transfusions. Care of abandoned newborns, feeding and growing. Peds ICU RN with demonstrated leadership abilities through Pediatric trauma, Intensive care and Neonatal Medicine.
EDUCATION
Bachelor of Science in Nursing
University of Texas Health Science Center at San Antonio
2001
Associates in Applied
Pace University and Beth Israel School of Nursing -
New York, NY
1987
SKILLS
Microsoft (10+ years), Internet (10+ years), Interpersonal Skills (10+ years), Management Experience (10+ years)
MILITARY SERVICE
Service Country: United States
Branch: Army
Rank: MAJOR, Chief Nurse, Officer in Charge of operations, Case Management
November 1987 to July 2013
Supervision of operations of numerous physicians, nurses, dentists and dental tech, EMTs, paramedics and administrative support, over 45 troops in total. Coordinated, managed medical and dental exams, for adult and indigent children living on the Texas /Mexico border. Provided immunizations to children, provided IV Infusion therapy in the homes and clinics for those children in need. Evaluated work performances, counseling statements and awards for deserving soldiers. Selected by Command to join task force to establish standard operating proceedures in case management, to soldiers returning from deployment from overseas and homeland missions, in accessing benefits after incurring injuries after returning from their missions. "Texas Med Hold'em'' arranged medical care, follow up appointments, and ensure referrals were initiated for medical necessity, precertification for procedures, length of stay and home health providing cost containment.
Commendations:
Leaders of Healthcare Network, in Nursing Magazine. .
*Received Commitment of Excellence Award at Humana Health Care Plans, 1994.
*Recognized for becoming the "Officer of the Month" six times.
*Four out of the six nurses I "Mentored", became Office administrators/ Managers and received their own Urgent Care Clinics throughout New York.
AWARDS
Army Commendation Medal
July 2005
The Army Commendation Medal is awarded to any member, other than General Officers, of the Armed Forces that distinguishes himself or herself by heroism, meritorious achievement or meritorious service which are of a lesser degree than that required for the Bronze Star Medal. The act justifying the award may entail aerial flight, and it may be made for noncombatant-related acts of heroism, which do not meet the requirements for an award of the Soldier's Medal.
These acts must have been performed after 6 December 1941, while serving in any capacity with the Army. A member of the military service of a friendly foreign country who, after 1 June 1962, distinguishes himself/herself by an act of heroism, extraordinary achievement, or meritorious service, if it has been of a joint benefit to both his/her nation and the United States may also be awarded the Army Commendation Medal.
International Nursing Association
June 2015
Awarded and Published in the International Nursing Association, Leaders in healthcare, 2015.
Top Leaders in America's Top Leaders, Healthcare Network in Nursing Magazine.
February 2013
Recipient of the leaders in America's Top Leaders, Healthcare Network in Nursing Magazine. Diverse group of hospital systems and networks, and our leadership development work with thousands of ... leading the patient-care experience as they foster a ... Engaging doctors, nurses, and other caregivers in shared ownership of the patient-care experience Journal of Healthcare Management, 55(3), 206–222.
Commitment to Excellence Award at Humana Healthcare Plans, 1994
September 1994
"Becca ill has an unwavering commitment to excellence and a lifelong commitment to Humana. Her leadership, teamwork and decision-making skills were applauded as well as the work that she does to make the safety and comfort of the Humana community her top priority".
October 2012
Recognized for Becoming " Officer of the Month" six consecutive times in a 12 month period
April 1992. Flashner Medical Partnership, Urgent care Facilities. 98 % patient satisfaction in six consecutive months. Six of the Eight Nurses I trained and mentored received their own Offices to run.
CERTIFICATIONS
BLS for Healthcare Providers
July 2018
Contact this candidate