Medical Manager
Resume:
Martine Acosta, Registered Nurse
**** ****** ***. ********, *****, 78539
Cell 956-***-****
Nix Hospital, San Antonio TX- August 2015 to present
Trauma Nurse Consultant on Contract
Ascertain that all Process Improvement plan is in place for opportunities identified through review of charts and trauma Program. Guide, educate and assist Trauma Coordinator on preparation for Level IV trauma designation. Assist with staff Education across the hospital. Review of minutes and assist in Coordination of EMS meetings.
Director of Case Management- August 2013 to present
Life Care Hospitals of South Texas
Responsibilities include oversee the Case Management Department for both Life Care Hospitals of South Texas. Oversee the daily operations of the Case Management Department and the Clinical Documentation Specialist Department. Assist with physician education on proper documentation. Monitor length of stay, avoidable days, team conference and oversee the daily scheduling for staffing. Educate and lead the Case Management Department. Assist as a resources person for both Departments by ensuring regulatory compliance. Monitor admissions criteria and guide team to ascertain proper transitioning of patients when lower level of care is needed. Assist with appeal and denials process for medical claims denied by insurances.
Clinical Documentation Specialist- January 2013 to August 2013
Rio Grande Regional Medical Center
Responsibilities included reviewing of medical records to capture clinical opportunities from physician documentation. Initiate queries when needed to help clarify and specify medical diagnosis. Educate physician on proper documentation.
Lead Case Manager – October 2010 was PRN, from August 2011 to December 2012 Full Time
Edinburg Regional Medical Center and Edinburg Children’s Hospital---South Texas Health System
Oversee the Case Management Department. Responsibilities include, revise policies, utilize and apply the interqual criteria to ascertain patient is in the right admission status. Ongoing chart reviews to make sure that the Core Measures are implemented on appropriate patients. Supervise day to day activities within the Case Management Department. Complete reports for length of stay, oversee the departmental Patient Improvement Team, and complete statistical reports for CFO and administration. Process any denials from the different payer’s sources through the appeal process.
Utilization Review Nurse - October 2010 to August 2011
Doctors Hospital at Renaissance
Assisted in developing policies and procedures for RGV Preferred Health Care to obtain UR Licensure and obtain HMO Licensure. Monitor and track the complaint and appeal log for the Utilization Department. Monitor, review and process all clinical requests for utilization and medical necessity for RGV Preferred Health Care. Refer cases to the Medical Director for review when screening criteria Interqual/Milliman were not met.
System’s Infection Control Coordinator - September 2009 to October 2010
South Texas Health System
Oversee the Infection Control Department for five Hospitals. Monitor the day to day activities of the Department. Complete reports for Health Care Acquired Infections such as Central line Infection, Ventilator Acquired Infections, and Urinary Catheter Infections. . Review charts according to CDC guidelines to determine Health Care Acquired Infections, and report notifiable conditions to the Health Department.
Case Manager- PRN WEEKENDS- April 2007- October 2010
Doctors Hospital at Renaissance
Review admission status, monitor, assess and coordinate any discharge needs for the patients to ascertain a safe discharge home. Chart reviews to ensure continuation across the continuum of care appropriate for the patients.
Trauma Coordinator- July 2006 to September 2009
Edinburg Regional Medical Center---South Texas Health System
Responsibilities include rounding on trauma patients to assess, identify, monitor, quality of care and timeline of care rendered. Analyze, review and address problems identified for patient improvement and loop closure. Work closely with Medical Director to assist in organizing trauma committee meetings and for review of morbidity and mortality records. Assist in arranging community fairs and education for staff. Attend Allied Health and the Regional Advisory Council meetings.
System’s Employee Health Coordinator - December 2005 to July 2006
South Texas Health System
Responsibilities included oversee Employee Health Department, supervise staff, and attend designated meetings. Develop and implement a Wellness program. Organize vaccination clinics for employee staff and community. Assure that Joint Commission, OSHA, Niosh and the Health Department standard were met.
Case Manager and Utilization Review -August 2002 to December 2005
McAllen Medical Center South Texas Health System
Responsibilities included review of medical records for utilization review, coordinate high quality patient care in a cost effective timely manner. Lead weekly team conference meeting and coordinate all auxiliary care for a safe discharge prior to patient leaving hospital.
Registered Staff Nurse: WEEKEND FLOAT POSITION- August 1997 to August 2002
Christus Spohn Health System Shoreline
Responsibilities included total patient care, and charting according to Hospital policies. Other duties at times included charge nurse and/or resource nurse, which included completing nursing assignment for unit, overseeing nursing staff and assisting with critical thinking skills and decision making for optimal patient care.
Assistant Director of Nursing- February 2000 to August 2002
Life Care Of America
Responsibilities included organize and supervise overall nursing personnel. Oversee daily schedule staffing to provide quality care for patient. Interview and monitor new employees, counsel inappropriate performance by nursing personnel. Address any complaints from patient, families or nursing personnel.
Registered Staff Nurse - April 1996 to February 2000
Corpus Christi Medical Center
Responsibilities included total patient care according to Hospital protocols, and charting according to Hospital policies.
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