DEBRA BUENROSTRO, R.N.

San Antonio, Boerne Tx. 210-***-**** ad12jt@r.postjobfree.com

OBJECTIVE:

Position myself as an asset within an organization, offering new challenges, leadership, and foundation for growth, where I can build upon my vast experience within Case Management, Health Education Management and Mental Health, Legal Review and Sales.

45 years RN clinical experience

27 years Case Management experience

26 years Inpatient Psychiatric Nursing, Behavioral Health and Workers’ Compensation Case Mgmt

15 years marketing experience

3 years Medical Surgical in Hospital Clinical and Supervisory

2 years Triage

5 years School Nursing

EXPERIENCE:

Nurse Case Manager San Antonio, Tx 11/28/22- 09/28/23 Panoramic Healthcare

•Conducted comprehensive assessments that include the medical, behavioral, pharmaceutical, and social needs of the patient, identify gaps in care and barriers to good health; The RN Care Manager is expected to conduct approximately 12 assessments per week and manage a panel of about 150 assessed patients.

• Based on this assessment, and in conjunction with the patient, patient’s nephrologists & PCP, and other members of the care team, create and implement a care plan that will address identified needs, remove barriers to care, and improve the health of the patient;

• Coordinate care by serving as the advocate and resource for the patient, their family, and their provider(s); • Facilitate care across the continuum of care, spanning settings such as the home, hospital, skilled nursing facility, and acute care facility;

• Manage patients during periods of transitions of care to facilitate effective transitions and minimize avoidable readmissions;

• Assess the patient’s knowledge of their renal condition and provide education and self-management support;

• Provide ongoing reassessment and follow-up to improve patient outcomes and Triage patients calling in to call center for medical, behavioral advice

Field/Telephonic Nurse Case Manager Workers Compensation-San Antonio, Compact States. 3/15/2022- 11/23/22. Spectrum Healthcare Resources Contract

Provide Workers Compensation Case Management supporting the US Department of Labor, Office of Workers Compensations (OWCP) and the Division of Federal Employees (DFEC).

. Provide medical case management to assigned workers compensation cases, with follow-up to employers, health providers and injured workers to assess and facilitate all medical needs to effectively provide a safe return to work within the Federal Government. Population includes injured workers with work injuries with chronic health conditions of Diabetes, Hypertension. Psychiatric conditions as Depression, PTSD, and Anxiety. Catastrophic injuries to include Head Injury and Orthopedic injuries.

Nurse Care Manager- Fulltime Remote/Field, San Antonio, Tx. 6/7/21- 3/18/2022

Somatus Kidney Care:

•Conducted comprehensive assessments that include the medical, behavioral, pharmaceutical, and social needs of the patient, identify gaps in care and barriers to good health; The RN Care Manager is expected to conduct approximately 12 assessments per week and manage a panel of about 150 assessed patients.

• Based on this assessment, and in conjunction with the patient, patient’s nephrologists & PCP, and other members of the care team, create and implement a care plan that will address identified needs, remove barriers to care, and improve the health of the patient;

• Coordinate care by serving as the advocate and resource for the patient, their family, and their provider(s); • Facilitate care across the continuum of care, spanning settings such as the home, hospital, skilled nursing facility, and acute care facility;

• Manage patients during periods of transitions of care to facilitate effective transitions and minimize avoidable readmissions;

• Assess the patient’s knowledge of their renal condition and provide education and self-management support;

• Provide ongoing reassessment and follow-up to improve patient outcomes

• Provide clinical oversight to non-licensed support team of community health workers and health coaches and licensed support team of social workers and renal dieticians, and delegate tasks as appropriate MEASURES OF SUCCESS:

• Provider Relationships. • Dialysis Interventions monitoring and coordination.

• Medical Management and Triage

Hospital Nurse Case Manager- Contract Assignment due to Covid

Aerotek Staffing Legent Orthopedic Surgical Hospital San Antonio, TX

July2020-Sept,2020

Provide expertise and leadership to ensure resource management for inpatient care, outpatient or same day surgery delivery for surgical patients. Responsible for the enhancement of continuity of care and cost effectiveness. Meet with surgical patient to assess their current and discharge needs and keep patient and family updated on discharge plan.

Daily and concurrently involved in the management, assessment, planning and intervention of patient care using the evidenced base guidelines.

Provides utilization review to all insured payer sources, providing updates on treatment progress and discharge disposition to Medicare, Medicaid Military and Commercial Payors

Collaborates with treating physicians, interdisciplinary team members to ensure appropriate inpatient medical-surgical care and transition a safe discharge consulting the patient and family and linking them to community resources and Inpatient Rehab Facilities. 6 month contract assignment or less pending return of employee from medical leave.

Telephonic Case Manager

YORK RISK/ SEDGWICK INS. San Antonio, Tx. May 2019- Feb 21,2020

Provided medical case management to assigned workers compensation cases, with follow-up to employers, health providers and injured workers to assess and facilitate all medical needs to effectively provide a safe return to work at a Carrier’s level. Population includes injured workers with work injuries with chronic health conditions of Diabetes, Hypertension. Psychiatric conditions as Depression, PTSD, and Anxiety. Catastrophic injuries to include Head Injury and Orthopedic injuries.

Medical Case Manager, UR Nurse

TRISTAR Managed Care San Antonio, TX. May 2015- June 2017

Perform Utilization Review activities prospectively, concurrently or retrospectively with complete and timely reports to clients and providers.

Using clinical/nursing skills to determine whether all aspects of a patient’s care, at every

Interfacing with external agencies/representatives relative to the utilization review process including, but not limited to, Third-Party Payers, Insurance Companies and Providers.

Screening provided medical information and medical records for medical necessity and appropriateness, comparing information to current medical criteria.

Referring for Physician Review those cases not meeting our medical criteria.

Provided telephonic medical case management to assigned workers compensation cases, with follow-up to employers, health providers and injured workers to facilitate all medical needs to effectively provide a safe return to work at a Carrier’s level.

Case Manager II, Behavioral Health

MOLINA HealthCare San Antonio, TX Aug 2014 -May 2015

. Provide care coordination, discharge planning and utilization review for members in

inpatient/outpatient settings. Assess patient’s behavioral, chronic/complex health needs.

Develop appropriate plans of care. Coordinate care delivery processes. Monitor and update treatment plans as needed. Participate in interdisciplinary team meetings.

Maintain company policy and guidelines of all payer sources and ethic and standards of practice of professional Psychiatric Nursing and Case Management.

Case Manager/ Denial Coordinator

Doctors Hospital at Renaissance McAllen, TX Mar 2013 – Aug 2014

Developed new department from clinical aspect working with multidisciplinary on denial issues, regulatory and payer requirements

Liaison to payers, Business Office/ Revenue Cycle Services. Provided clinical review and letters of appeal for all medical necessity and length of stay denials issued by third party and government payers.

Provides education on improving clinical documentation. Coordinates Advising/Attending physician participation in concurrent peer to peer, 2nd and 3rd level appeals according to contract requirements.

Supervises clerical staff on data entering and preparation of statistics and reports. Maintains current knowledge of case management, utilization management, and discharge planning as specified by federal, state and private insurance.

Hospital Based Internal Case Manager

Christus Spohn Memorial Trauma Hospital Corpus Christi, TX Nov 2011 – Jan 2013

Provides expertise and leadership to ensure resource management for inpatient care delivery. Responsible for the enhancement of continuity of care and cost effectiveness.

Daily and concurrently involved in the management, assessment, planning and intervention of patient care using the evidenced base guidelines.

Provides utilization review to all insured payer sources, providing updates on treatment progress and discharge disposition

Collaborates with treating physicians, interdisciplinary team members to ensure appropriate inpatient medical care and transition a safe discharge consulting the patient and family and linking them to community resources.

Medical Case Manager/ Bilingual

Providence Risk Insurance TPA San Antonio, TX Apr 2011 – Sept 2011

Provided education to adjusters regarding the medical management of non-subscriber work injury claims, with consultation covering complex medical issues surrounding pre existing conditions, extent of injury, anticipating length of disability and duration of optimal medical treatment

Responsible for writing all letters to physicians for Independent Medical Examinations and Peer Review

Served on the management team, supervising clerical assistants.

Field Case Manager/Bilingual

INTRACORP Phoenix, AZ Nov 2010 – Feb 2011

Provide medical case management to assigned workers compensation cases in Arizona. Managed and facilitated all medical needs to effectively provide a safe return to work.

Field Case Manager/Bilingual

LIBERTY MUTUAL Phoenix, AZ Jul 2007 - May 2009

Provided medical case management to assigned workers compensation cases, with follow-up to employers, health providers and injured workers to facilitate all medical needs to effectively provide a safe return to work at a Carrier’s level.

Field Case Manager/Bilingual

CONCENTRA MANAGED CARE Phoenix, AZ Oct 2006 – Jun 2007

COVENTRY HEALTHCARE

Provided medical case management to assigned workers compensation cases, with follow up to employers, health providers and injured workers to facilitate all medical needs to effectively provide a safe return to work at a vendor’s level.

Nurse Case Manager

RSKCO/CNA INSURANCE CO San Antonio, TX Nov 2000 - Nov 2002

Provided telephonic and field case management to insured’s of the carrier for timely return to work of their injured employees.

ADDITIONAL EXPERIENCE:

Early Intervention Telephonic Case Manager

CONCENTRA MANAGED CARE, San Antonio, TX Mar 2000 - Nov 2000

(Royal Care Sun Alliance)

Medical Case Manager

GENEX SERVICES, INC. San Antonio, TX Mar 1999 - Mar 2000

Integrated Care Coordinator - Utilization Review Department

MEDINIGHTS, INC. Austin, TX Aug 1998 – Mar1999

Medical Case Manager

FORTE MANAGED CARE Austin, TX Aug 1997 – Aug1998

Rehabilitation Coordinator/Medical Case Manager

TEXAS WORKERS COMPENSATION FUND Austin, TX Jun 1996 - Aug 1996

Medical Case Manager, Disability Managed Care

KEMPER NATIONAL SERVICES Austin, TX Jun 1995 - Jun 1996

Medical Case Manager - Disability Managed Care Firm

INTRACORP Austin, TX Aug 1993 – Jun 1995

Southwest Mental Health Facility San Antonio, TX. Feb 2003 – 7/06

Charge Nurse Weekend PRN

Charge Nurse Duties for psychiatric inpatient children ranging from ages 3-18. Supervised mental health workers in the delivery of patient care.

HARLANDALE INDEPENDENT SCHOOL DISTRICT, San Antonio, TX 11/02-9/06

School Nurse

School Nurse for two campuses (Charles N Boggess Learning Academy and Frank Tejada Academy).

Duties included psychiatric nursing support for children with psychiatric overlay and Special Education needs that prevent them from functioning on a regular school campus. Worked with a therapeutic team including the school psychologist. Accountable for ensuring state medical compliance for vision, hearing, immunizations and scoliosis screening and the students remained in compliance with psychotropic medications prescribed. Met with parents to assure proper understanding and compliance with student’s treatment plans and school program goals. Provided first aid. Provided nursing support and guidance to at risk children (teen pregnancy, drug related issues and truancy).

Additional Medical Surgical Experience:

8/88 – 5/93 - BAPTIST HOSPITAL OF ARKANSAS

Psychiatric Unit 2 yrs

Assistant Director of Nurses for Rehabilitation Institute for 11-7 shift. Supervised Fifty-Five (55)

Employees. WE0 Charge Nurse, Psychiatric unit.

Medical Surgical Women’s Health 2 yrs

Medical Surgical Women’s Health GYN Medical/Surgical Floor- Provided bedside

Clinical Nursing to women with medical surgical needs pre and post surgery. 2 yrs

2/79 – 3/80 - VISITING NURSE ASSOCIATION – San Antonio, TX

Home Health Nurse 1 yr

Provided bedside clinical care to medical and surgical patients in the home. Provided medical treatment and education ordered by physician to patients with complex medical problems to include IV administration, gastric feedings and diabetic teaching and provided post surgical care to include sterile dressing changes in the home ordered by the physician and report progress to determine on going home treatment plan.

6/73 12/74 - METHODIST HOSPITAL -San Antonio, TX 1/1/2 yrs

Medical Surgical Nurse

Provided bedside clinical nursing to patients having medical and surgical needs.

EDUCATION:

Associate Degree in Nursing 1973

San Antonio College School of Nursing

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