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Manager Medical

Location:
Henderson, Nevada, United States
Salary:
Highest pay for this job
Posted:
November 29, 2017

Contact this candidate

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

Henderson, NV *****

Phone: 702-***-****

Masayo Hanyuda

OBJECTIVE: My primary objective is to incorporate my skills, knowledge, and experience into the fabric of a quality company, so as to further develop and enhance the positive

aspects and prosperity of the business, along with furthering my personal business

growth.

QUALIFICATIONS: Recognized for ability to rapidly identify problems, formulate appropriate plans and Initiate action. Marketing, Negotiating, Contracting. EFMP (exceptional family Member program coordinator, Overseas clearance review, Progressive experience in Data collection and Analysis of Cardio Thoracic Surgery, General Surgery, Congestive Heart Failure, Community Acquired Pneumonia. Experience in Proactive Nurse Case Management, Workers’ Compensation management, and Occupational Nursing. On site investigation and Education, H.R. advocate, OSHA safety and Medical industry compliance, Chemical dependency advocate, Microsoft MS Word, MS Excel, and MS Power Point, Composite Health Care System (CHCS), AHLTA.

EDUCATION: BSN, Andrews University, Bachelor of Science in Nursing.

ANS, Sinclair College, Applied Science Degree in Nursing.

CERTIFICATE: Active Nevada Nursing License. CPR and First Aid Certified.

OSHA management.

Right to know annual Chemical Exposure training.

Ongoing Cardio Vascular surgeons meetings.

** I am CCM Certificate Eligible

SPECIAL SKILLS: Speak / read/ write fluent Japanese and English

EMPLOYMENT:

September, 2016 to present time Moved back to NV state and seeking for a new job

I completed my job at the VAFB and moved back to Henderson, NV where my old

high school friend lives. My old friend lost her husband and I felt alone in CA that

I felt we can help each other. I also missed my church that I feel made a good

decision for both of us. I stayed at my old friend’s house for two months searching

for a house and finally found one nearby friend and settled finally.

May, 2014 to September, 2016 Utilization Manager / Vandenberg AFB

As Utilization Management, reviews for medical necessity, pre-authorization, medical appeals, collection and recovery from insurance carriers, and right of refusal activities, MEB monitoring and process. Worked with the executive staff of clinical operations, resource management, medical records, patient administration / Tri Care system and the staff, and the quality division within the managed care facility to provide the appropriate level of resources and minimize cost. Worked with Case Manager, EFMP rep, Wounded Worrier and Health Integrator as a 30th MDG Care Coordinator and exchanged patients information in daily bases to update the status. Had Care Coordination meeting weekly and clinical staff meeting in daily bases to notify, update, plan strategy to facilitate patients recovery. Our CC-members had the same knowledge of patients to help each others to update and corroborate enhanced patients care in timely manner. I used VAFB CHCS & AHLTA systems to retrieve all VAFB members’ medical & geological information, health status, use of resources and their needs in daily bases under the HIPPA regulation. Monitor all the patients to exchange information among CC-members and clinical staffs to enhance care in timely manner, document communication on the AHLTA to update the status. For an example, I have developed off base local provider’s access through SGH and Hospital Executive and IT members that I could identify any emergency issues with our patients and the follow up with our PCM in timely manner. I notify patients’ PCM immediately per AHLTA and collected documentation update for the patient so that the physician knows what the next steps to take is. Communicate with EFMP rep to see who is good candidate for the EFMP services, notify Case Manager who is in ER or inpatient at the time and next steps to follow up. If Wounded Warrior requires any special care, CC-members corroborated each other and helped the process together.

I myself used to work as an EFMP coordinator in the past years and I used to work with Dr. Silver who was SGH and did overseas clearance with me. Identify EFMP candidate and have a meeting with the family or patient to coordinate and provide their needs best we could. Many were very happy with my work at that time and we were awarded by Base Commander.

December, 2013 to May, 2014 Seeking for a new job and moving to CA process

I was looking for a new position and also volunteered work at my church at the time. Meantime received a call for VAFB Utilization Manager Position offer. I had to collect all the required process and preparation for the moving process and stayed at the guest court on base for time being.

June, 2013 to December, 2013 Case Manager / Kindred Hospital

As Case Manager, transitional Hospital with the difficult to treat, chronically critically ill patients who require specialized aggressive goal directed care over an extended recovery period that focused on individualized tailored care with appropriate level of care to facilitate patients’ recovery and appropriated transitional placement.

December, 2012 to June, 2013 Volunteer for Animal Foundation / Church services

I volunteered to provide dogs and cats in daily needs. Provide love and care for their needs, cleaning, play with them and regain the trust for humans. I believe in its mission in our community to engage humanity. I also volunteered serving at my church kitchen to prepare refreshments & snacks for attendees, cleaning after the service and get ready for next services.

February, 2012 to December, 2012 No employment

I had an auto accident in February, 2012 and had back surgery in March, 2012. The accident was an elderly hit me from behind at the red traffic lights on a way home from work and my car was towed and orthopedic surgeon suggested me to have a surgery.

October, 2011 to February, 2012 Workers’ Comp Case Manager / United Healthcare

Worked as Telephonic Workers’ Compensation Case Management in office setting. Follow up with injured workers and their employer to accommodate job availability at work, rehab plan and schedule for the patients, recovery strategy, minimize lost time and facilitate recovery and return to work. (Left this job due to car accident)

April, 2009 to October, 2011 Private Duty RN / Arroyo Grande Home

Worked with Mesothelioma Cancer patient who was my partner at that time. Pre-op to post-op care at the patient’s home through Hospice period. I moved to Henderson, NV in the end of September, 2011 due to the patient’s family request for me to leave the patient. The patient deceased in October, 2011.

June, 2009 to December, 2009 Telephone Case Manager / Welcomp, Spectrum, EK-

Health Agents Company

Part time Telephonic Case Management as needed and Telecommute.

April, 2008 to April, 2009 Utilization Management / Exceptional Family Member Program, Vandenberg AFB

As Utilization Management, reviews for medical necessity, pre-authorization, medical appeals, collection and recovery from insurance carriers, and right of refusal activities. Work with the executive staff of clinical operations, resource management, medical records, patient administration, and the quality division within the managed care facility to provide the appropriate level of resources and minimize cost.

As EFMP(Exceptional Family Member Program) coordinator, identify special medical and educational service requirements of family members in support of active duty sponsor reassignment and civilian employment overseas. Process a set of interrelated activities within the medical treatment facility and with multiple base and community agencies to support sponsors and their family members. Directly support the EFMP through the application of medical information technology and the sharing of global resource information to ensure appropriate relocations of family members. Coordinate identification of ongoing needs assists with the continuity of family member care through the sponsor’s permanent change of station and temporary duty. Perform family member relocation clearances by medical review and face to face interview with the family and corroborate determination with the Chief of the Medical Staff to assure all the services are available at the destination.

April, 2004 – Dec, 2006 Case Manager / Employee Health, Fallbrook Hospital

Assess medical records for appropriateness, level of care provided, and criteria determination. Work with treating physicians and nurses in facilitating recovery and discharge. Collaborate with patient’s family, medical vender, and home health, rehabilitate to assure patients optimum recovery. Work with Medical/CMS patient for placement.

October, 2002- March, 2004 Data Analyst, Tri City Medical Center

Collect data and analysis for Cardio Thoracic Surgery and report the results to STS (Society of Thoracic Surgeons) and to CCORP (California CABG Outcomes Reporting Program). Data collection, analysis, and plan to improve CHF (Congestive Heart Failure) and CAP (Community Acquired Pneumonia) patient’s recovery and their self care at home. Participation of California CHF and CAP program.

September, 2001- October, 2002 Case Manager, Tri City Medical Center

Assess medical records for appropriateness, level of care provided, and criteria determination. Work with treating physicians and nurses in facilitating recovery and discharge. Collaborate with patient’s family, medical vender, and home health, rehabilitate to assure patients optimum recovery. Work with Medical/CMS patient for placement.

July, 2000 – June, 2001 Case Manager and Utilization Review, E.O.S (Reviewco)

Assess medical records for appropriateness, level of care provided, and criteria determination. Work with claims examiner regarding utilization of treatment, modalities, medications, and services provided. Apply treatment protocols to Workers’ Compensation system. Work with treating physicians, research and resolve client’s workflow issues and program production with client’s supervisor to facilitate the client’s return to work.

January 1989 – April, 2000 Health Care Administrator, American Matsushita Electronics Company (Panasonic)

Established employee’s health care system. Established preventive health care program and developed in house GYM. Self-insured Workers’ Compensation management established in 1994. OSHA regulatory compliance programs completed. Formulated ongoing health and safety policy and regulation. Designed new employee health care orientation and application. Reduced medical cost 30% by well-organized medical follow up system development and personal care. Established health maintenance program for executives. Planed purchasing medical products and marketing arrangement. Formed employee assistant program management.



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