Management Customer Service
Resume:
Mary Carol Ramos, Ph.D., R.N.- B.C,
C.P.H.Q., C.P.U.M., C.M.A.C., C.C.M.
San Antonio, Texas 78259
Home 210-***-****
Qualification Highlights
$ Specialized expertise in health care education, clinical practice standards, clinical management,
quality management, case management, program design and development, utilization
management, risk management, infection control, and research-based practice improvement
$ Comprehensive education and experience in health care research, including research design,
implementation, research ethics, qualitative analysis, statistical analysis, survey and instrument
design and psychometrics
$ Extensive experience in Military Healthcare Delivery systems, including Case Management,
Development and Implementation of Clinical Practice Guidelines, Population Health, and
Seamless Transition between Military and VA delivery systems
$ Analysis of available healthcare outcomes data for analysis and process improvement planning
$ Utilization of Electronic Patient Record systems in capturing healthcare outcomes data
$ Expertise in regulatory agency interface, including JCAHO, OSHA, NCQA/HEDIS, HCFA, HIPAA
(Privacy Rules and Regulations, Administrative Simplification and Coding), ICD
$ Experience in complex project management, focused health care education, strategic planning
and market research in care delivery
$ Appreciation of the role of health care legislation and policy in the delivery of high quality patient
care
$ Familiarity with application for research funding and grantsmanship. Success in obtaining NCI
funding for multiyear, multi-millions dollar federal cancer project
$ Certification in healthcare quality (current), utilization management, case management
administration, and past certifications in nursing administration and managed care
$ Broad experience in managed care, both direct care and payor settings
$ Experience in data base building and data mining to support administrative decision making
$ Thorough understanding of health care information systems, coding and utilization of financial,
encounter, and coded data to support health care quality improvement decision making
$ Experience in health care risk management activities and policy-making
$ Excellent oral and written communication skills with broad experience in professional publication
and presentation
$ Investment in working with individuals at all organizational levels
$ Strong computer skills; experienced using PC-based (Microsoft) office software, including
spreadsheet analysis, word processing, presentation, database software, publication software,
PC-based statistical analysis software, SQL
Mary Carol Ramos Page 2 of 6
Work Experience
University of Texas Health Science Center San Antonio 2010 - Present
School of Nursing
Department of Health Restoration and Care Systems Management
Adjunct Faculty
United States Department of Veterans Affairs
Central Office, Washington D.C.
Federal Recovery Coordinator 2008 – Present
• Lifetime care coordination for most seriously wounded, ill, and injured Service Members and
Veterans
• Coordination of health care and benefits services between Department of Defense and
Department of Veterans Affairs
• Development of Care Coordination management software and data bases
• Development of Care Coordination Policies, Procedures
United States Army Medical Command
Quality Management Division, Evidence-based Practice Branch
Medical Management and Clinical Practice Guidelines Coordinator 2005 – 2008
• Leadership across US Army in transition to unified Medical Management system from
isolated Case Management, Disease Management, and Utilization Management
• Service on OTSG-level committees for planning patient- and family-centered health care
initiatives
• Service in Triservice/VA case management redesign bodies
• Faculty on TMA (Triservice) Medical Management Teaching efforts
• Coordination of Population Health outcomes quality initiatives across the U.S. Army Medical
Command
• Coordination of development, implementation, and evaluation of evidence-based Clinical
Practice Guidelines. Current coordination of behavioral health, pain control, PTSD, and post-
deployment health CPGs
• Coordination of purchasing and inventory control for warehouse systems in dispersal of
educational materials in support of CPGs
• Support of DoD-level policies and procedure development concerning Case Management
and evidence-based practice
• Budget management for Evidence-based Practice Branch
University of Texas Health Science Center San Antonio
San Antonio Cancer Institute
Cancer Prevention and Population Science Program Coordinator 2004 – 2005
• Development and implementation of community-based cancer support resources for
population in central south Texas
• Support of grant writing for funding of NCI-designated Cancer Center
• Grant writing (NCI) to develop support for community-based programs for disenfranchised
populations
Mary Carol Ramos Page 3 of 6
Work Experience (cont)
Joint Commission
Field Representative (50%) 2003 – 2004
Nurse Surveyor, HAP
Christus Santa Rosa Children’s Hospital, San Antonio, Texas
Quality Management Coordinator 2003 – 2004
• Quality Management Pediatric Hospital
Staff Nurse 2002 - 2003
Pediatric Hematology and Oncology
• Clinical practice in pediatric hematology, oncology, palliative care, and general pediatrics
• Committee representative to quality and pain management task forces
Graduate Nursing Program Faculty
University of Phoenix Online 2002 - 2006
Online instruction: Master’s level nursing research sections
Director, Case Management and Quality 2000 - 2001
Las Palmas Medical Center, El Paso, Texas
200-bed for-profit medical center in underserved border community. High proportion uninsured with complex
chronic illness and complicated discharge needs
• Design and implementation of Performance Improvement, design and implementation of Case
Management Program with Utilization Management, Denials Management components, HIPAA
Compliance with extensive staff education program design and implementation
• Coordination of JCAHO survey with extensive staff education program design and implementation
• Interface with Risk Management, legal implications of practice and patient safety initiatives
•
Corporate Director, Medical Management 2000
Schaller Anderson Inc, Phoenix, Arizona
Owners and administrators for five managed care plans, four Medicaid, in five states. Approximately
150,000 covered lives with claims administration and administrative functions centered in Phoenix.
• Supervision of prior authorization for two plans and after-hours customer service for all plans
• Coordination of HEDIS survey and staff education for three Medicaid plans in three states
• Coordination of disease management plans across plans
• Coordination of utilization management and quality management functions across plans
•
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Work Experience (cont)
Director, Clinical Resource Management, 1998 – 1999
Phoenix Children’s Hospital, Phoenix, Arizona
Arizona’s only independent pediatric facility, within Good Samaritan Regional Medical Center. Ninety-five
hundred admissions in 1998, 35,000 outpatient visits. Primary, tertiary, and quaternary, care in 74 general
pediatric beds, 18 biobehavioral beds, 92 nursery, 14 subacute, and 21 intensive care beds. Young
organization in transition to freestanding status.
• Implementation, support and management of case management services
• Supervision of Admissions office processes and personnel
• Oversight of regulatory interface including coordination of JCAHO survey and staff education
• Design of integrated utilization/denials management programs
• Design, implementation of case management outcomes measures
• Coordination of quality management and case management functions and staff education
• Analysis and redesign of process for writing, revision, and implementation of administrative and health
care policies and procedures
• Development of policies and quality-risk management interface with legal services
Director, Case Management 1997 - 1998
St. Francis Hospital, Columbus, Georgia
General Community hospital serving western Georgia and eastern Alabama. Emphasis on cardiovascular
services. Two hundred beds, no obstetrical services. High occupancy, brisk patient turnover, predominantly
Medicare population.
• Design and implementation interdisciplinary case management program: Integration of case
management, social work, and utilization review with concomitant staff education
• JCAHO survey preparation team
• Interaction and coordination of quality and risk management activities
University of Virginia, Charlottesville VA 1992 - 1997
Analyst, Regional Primary Care 1996 - 1997
Start-up unit for integration and support of 18 newly acquired primary care practices
• Compilation, analysis, and distribution of productivity, profitability, patient satisfaction, and wellness
documentation data
• Development of instrumentation and data-handling system for patient satisfaction data
• HEDIS education
• Collection and analysis of multiplier effect data
• Validity testing of RVU data
• Credentialing of health care professionals
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Work Experience (cont)
Clinical Analyst (University of Virginia, cont) 1994 - 1996
• Coordination of clinical staff and administrative clinical resource management (quality, risk)
• Research support for clinical and administrative decision-making for upper management
• Led efforts in Clinical Practice Improvement, enhancement of clinical quality systems, clinical practice
guidelines, and clinical pathway facilitation and implementation
• Clinical education concerning coding, documentation, applicability of clinical and financial data in
decreasing costs and length of inpatient stay while maintaining or improving clinical quality
• Project management for strategic planning, reorganization of clinical services within architectural and
construction planning
• Participation in Medicaid capitation proposal
Quality Management Coordinator 1992 - 1994
• Administration and support for quality improvement activities for 17 clinical departments
• Design and implementation of quality improvement plans
• Participation and coordination of risk management activities, case-finding, and data analysis
•
• Staff Nurse 1991 – 1992
• Charter Hospital of Charlottesville
• Renewal of clinical skills in mental health and psychiatric nursing
•
• Staff Nurse 1991
Medical Intensive Care Unit
University of Virginia Health Sciences Center
• Renewal of clinical skills in medical critical care
Graduate Instructor 1987 – 1989
University of Virginia School of Nursing
Charlottesville, Virginia
• Taught classes in graduate psychiatric nursing, graduate research methods, undergraduate
research, undergraduate clinical laboratory
• Research Center Associate assisting with grant applications and research administration
• Assisted with NLN survey preparation
Mary Carol Ramos Page 6 of 6
Education & Training
Degrees
Ph.D., Psychosocial Nursing and Research, 1990; University of Virginia, Charlottesville, VA
M.S.N., Psychiatric and Mental Health Nursing, 1988; University of Virginia, Charlottesville, VA
M.S., Community Psychology, 1984; Lamar University, Beaumont, Texas
B.S.N., 1975; University of Texas Medical Branch, Galveston, Texas
Diploma, 1969; Bronson Methodist Hospital School of Nursing, Kalamazoo, Michigan
Training Courses
Guided Care Nursing (Johns Hopkins)
Ongoing Comprehensive Training in VA Benefits
JCAHO New Surveyor Education
Coursework in Health Care Quality
Intermountain Health Care 1500 Hour Course in Health Care Quality Improvement 1994
Certification Course in Health Care Utilization Management
Coursework in Managed Care Management and Health Care Finance
Coursework in Health Care Administration
Course work in Regulatory Agencies, including JCAHO and HCFA
Certifications & Professional Affiliations
Board Certified in Case Management (RN-BC, ANCC)
Certified Case Manager (CCM)
Certified Professional in Healthcare Quality (CPHQ)
Certified Professional in Utilization Management (CPUM)
Certified Case Management Administrator (CMAC)
Certified Nursing Administrator (ANCC) expired
Professional, Academy for Healthcare Management
American Association for the History of Nursing
American Nurses Association
Association for Healthcare Risk Management
Association for Practitioners of Infection Control
Association of Pediatric Oncology Nurses
National Association for Healthcare Quality
Texas Association for Healthcare Quality
Texas Nurses Association
Honors & Awards
Phyllis J. Verhonick Nursing Research Award, 1991
Publications and Presentations Available Upon Request
Contact this candidate