Rosa Hernandez

Profile: Email: **** rosabenhernandez@96th Cell: St 806-Lubbock, 224-5451 TX gmail.79424 com

• • • • • • • • • Education: Intergy; Extensive Demonstrates Readily professionals. Relate conditions. Strong appropriate Proven Resourceful Dedicated required. Proficient eClinical well analytical record develop knowledge in individual; to in intervention. several Works; people aptitude of completing rapport reliability skills, Electronic from etc.of reputation easily for nursing with ) projects, a developing and variety assesses patients, Medical responsibility. care. for ability of consistently cultures new conditions families, Records to skills. multi-and staff, (going Cerner/and task socio-and implement beyond effectively. PowerChart; economic other what health is care

• • Work Graduated Graduate Plains Experience: College. with with Associate diploma Degree from Estacado in Nursing High in School December in 1998. 2010 from South WellMed Sr Clinical • • • • Develop Stars Provide executive Be markets corporate Participate review performance or Medical Regional the Quality measure primary meetings analytical market working summaries operations Management Consultant in leadership. and weekly, to go business related be within market to interpretation a person to and 4 monthly, (May Stars plan a to performance plans regional matrix Star 2022- for and or bi-to activities all higher. of provider relationship motivate weekly, market Present) Stars Stars as related and which requested quarterly, operations. groups. providers HEDIS which summarize activities by reporting, includes and/to or engage withing or required provider annual Quality including in assigned improving by business group Quality

• • • • Review group/approaches Focus Develop Gain submit access communications provider for provider solution Stars to and provider strategies. office measures. group based, operations and structure Electronic user efforts friendly and and Medical accordingly. initiatives characteristics, personnel Records to to support identify (EMR) provider to practice the collect most success. data effective and Centene Field • • Case Assess treatment treatment, Utilize Corporation- Manager assessment members plan and RN Superior provider and II current (July services, skills 2020- Health options. health and prognosis, May discretionary Plan status, 2022) resource short- judgment and utilization, long-to term develop past goals, and plan present of care based upon assessment with specific objectives, goals and interventions designed to meet members needs and promote desired outcomes

• Coordinate services between Primary Care Physician, specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio-economic needs of the clients

• Provide patient and provider education

• Facilitate member access to community-based services

• Monitor referrals made to community-based organizations, medical care, and other services to support the members overall care management plan

• Actively participate in integrated team care management rounds

• Identify related risk management quality concerns and report these scenarios to the appropriate resources.

• Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems.

• Direct care to participating network providers

• Coordinate services request/authorizations with UM and ensure agreement is aligned between the member, agency, and MCO

• Facilitate member to MCO-based services and programs in collaboration with agency staff

• Assist members with transportation to healthcare appointments

• Other duties as assigned

Accolade Home Health/ Texas Home Health (Accolade was purchased by Tx Home health on September of 2018, but did not go live with their system until March • • Oversight Review 2019) Clinical and of assess casework Supervisor client and treatment (professional March 2019- plans issues May including 28 of 2020) each short employee and long term goals

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