Registered Nurse Medical
Resume:
Flavio Correa
**********@***.*** - 786-***-****
Authorized to work in the US for any employer
WORK EXPERIENCE
United Healthcare. WellMed.
Inpatient Case Manager. (Medicare HMO). October 2014 to Present.
RN responsible for implement, monitor and evaluate actions required to meet the client’s health and human services needed. Supporting coordination and provide care for patient, appointments with PCP, specialist doctors, outpatient procedures such as MRI, CT, etc.
Coordination of services such as home health care, DME among others. Helping clients achieve wellness and autonomy. Helping patients make informed decisions by acting as their advocate regarding their clinical status and treatment options. Strong initiative and exceptional organizational skills, combined with my ability to work well under pressure, allow me to play a crucial role in fast-paced environment.
Inpatient case management role, responsible for notify the payer of all Outpatient Observation or Inpatient admissions to the hospital, confirm the pre-authorization or notification for services during the patient registration and financial clearance process and document the authorization or notification number as well as payer representative name and phone number in the hospital Admission/Discharge/Transfer to other hospital/hospice/LTAC center/SNF, or other. InterQual/Jiva experience.
. Reviews clinical information provided by hospitals/facilities to determine medical necessity
Coordinates care from admission through discharge
Discharge planning collaboration n
Assess readmission risks
Registered Nurse.
Registered Nurse - Prestige Health Care
Miami, FL
Prestige Health Care - Clinical Nurse Reviewer – October 2013 to September 2014
Responsible to conduct medical necessity reviews using evidence based clinical guidelines to review and evaluate all clinical services provided to our members. Supporting providers in delivering quality, evidence based care in an effort to reduce costly complications, optimize therapeutic outcomes, and improve the quality of life of members. Review and evaluation of all requests for elective inpatient admissions, and preauthorization.
Authorize inpatient and pre-authorization requests based upon evidence based UM. Managing
a daily inpatient census. Conducting initial inpatient review and determine appropriateness of admission, anticipated length of stay and potential discharge needs.
RN Per Diem
Miami Behavior - Miami, FL - 2012 to October 2016.
Behavioral health (Psych Nurse)
Registered Nurse: Ensuring the correct administration of medications, monitoring the results of medicated and non-medicated treatments, preparing care plans, and working with the families of the patients. As part of behavior treatment, responsible to encourage patient activities that reflect the patient's interests. Responsible for the well-being of the patient's physical needs, such as hygiene and proper diet, as well as mental duress.
Experience to contribute to policy development, quality improvement, practice evaluation, and healthcare reform.
Registered Nurse - Concurrent Review and Discharge Planning
Miami Behavior - December 2012 to September 2013
Utilizing Interqual to determine medical necessity / discharge planning
Conduct review for appropriate utilization of services from admissions through discharge.
Reviewing Hospital inpatient charts to determine length of stay, discharge edibility, etc.
Review admissions through on-site and telephonic review to ensure medical necessity and appropriate level
of care.
Provide patient and provider education - working with social workers post discharge
Review and audit patient charts through on-site hospital visits.
Act as clinical resources to referral staff and make appropriate referrals.
Data enters assessments, authorizations and reviews into the system
Communicate with physicians at regular intervals throughout hospitalizations and develops an effective working relationship.
Collaborate with clinical staff in the development and execution of the plan of care and achievement of goals.
Notify hospital case manager with or social worker to review discharge plan assisting with of post discharge services.
Responsible for participating in special projects, such as community program development, medical program development, research activities, community relationship-building activities.
Promote continuity of care and cost effectiveness during the process of case management, concurrent review and discharge planning for members at Jackson health plan.
Assist and follow-up patients with appointments for the patient see providers for follow-up and for discharge testing and the importance to compliance with medical and future treatments. Also defining what constitutes an emergency and what to do in case of emergency
Educate patients and continue to enforce education and patient understanding about his or her diagnostic, and medications.
RN Case Manager - Concurrent Review and Discharge Planning
Palm Springs Hospital - December 2011 to November 2012
Enhanced quality of patient management and satisfaction providing cost effectiveness through the integrating
and functions of case management, utilization review, management and discharge planning.
Reviewing Hospital inpatient charts to determine length of stay, discharge edibility, etc.
Review admissions through on-site and telephonic review to ensure medical necessity and appropriate level of care.
Interqual knowledge
Provide patient and provider education - working with social workers post discharge
Review and audit patient charts through on-site hospital visits.
Act as clinical resources to referral staff and make appropriate referrals.
Data enters assessments, authorizations and reviews into the system
Responsible to provide ongoing support and expertise through comprehensive assessment planning,
implementation and overall evaluation of individual patient needs.
Experience working at ICU and CCU units at Palm S.H. dealing everyday within Utilization review and
Discharge planning.
Administrator
Acqualina Medical Group, Inc - December 2008 to November 2011
License Massage Therapy.
Clinical massage therapists focus on the medical benefits of massage techniques for injury people specially after car accidents. Effective and ethical delivery of massage therapy, proficiency in SOAP charting and documentation. Knowledge of massage indications and contraindications also understanding of physiological developmental stages. Swedish, sport and deep tissue massage concentrating on rehabilitation techniques
and neuromuscular therapy.
License Massage therapist
Spa at Doral - Miami, FL - August 2000 to September 2004
Performs massage therapy and touch modalities, which include Deep Tissue, Aromatherapy, prenatal
massage. Maintains the treatment rooms in a neat professional manner including stocking products and linens,
cleaning and instrument sterilization. Replaces massage
linens on tables so that the room ready for the next client. Excellent customer service skills also
team player and flexible ability to retail home-care products
EDUCATION/LICENSE
• Florida College, Natural Health, FL - Massage Therapist License, Lic 29200
• Guadalupe Vocational Institute, FL - Certified in Mental Health Technician
• School of Medicine, Santiago de Cuba, Cuba - Medical Doctor
• I. P. S Octavio de la Concepción y de la Pedraja, Cuba - Registered Nurse
• Florida Registered Nurse (License 9260587) FL
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