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Quality Assurance Case Management

Location:
Ocean Grove, NJ, 07756
Posted:
February 10, 2024

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Resume:

MARILYN SANCHEZ, RN, MSN

** ****** *******

CLARK, NEW JERSEY 07066

973-***-****

ad3i57@r.postjobfree.com

CERTIFICATIONS

PICC

NUTRITIONAL ASSESSMENT

CHEMOTHERAPY

BCLS

EDUCATION

William Paterson University, - BSN

Kean University Graduate Program – MSN

Continuing education includes the following:

Total Quality Management, Case Management Training,

The Child Abuse Investigation and Reporting Workshop

Fluent- English/ Spanish Sigma Theta Tau International – International Honor Society of Nursing

Alpha Epsilon Lambda – National Honor Society

2022 – New Jersey Supreme Court Fee Arbitration Committee

PROFESSIONAL EXPERIENCE

2nd HOME

Adult Medical Day Care

February 2009 - current

Chief Nursing Officer

Reports directly to the owner of the company.

Responsible for 10 Adult Medical Day Cares throughout New Jersey. Responsible for all clinical and compliance issues.

Responsibilities, includes, preparation of all HMO contracts, United Healthcare, Amerigroup, WellCare, Healthfirst, Horizon and contracting with Molina.

Compliance with all regulatory agencies, to include client eligibility.

Responsible for Department of Health surveys, MCO audits, and clinical compliance.

Develop and implement the Quality Assurance Program, to include HEDIS QA, Risk Management, professional education, and caregiver.

Hire orient and supervise qualified management and administrative personnel.

Conduct, performance evaluation with a bonus structure on key staff.

Maintains open communication with all clinical staff. Hire, and train all clinical and ancillary staff.

Develop and implement policies and procedures. Establish relationships with referral sources and the community for marketing.

Organize and direct facilities ongoing functions in compliance with policy, procedure and legal requirements. Keeps governing body informed of facility status, progress needs, problems, changes and projected changes on a regular basis. Coordinates all contracting services, to include 30 physicians. Supervise all physicians and skill staff. Planning for and administration of managerial, operations, fiscal and reporting mechanism of all facilities.

Develop and implement methods for increasing census and retention of clients.

Conducted the first Value – Based Study in a Medical Day Facility.

Vice President Operations

August 2001- December 2009 Organizes and directs the center’s ongoing functions in compliance with policy, procedure and legal requirement. Hire, orient and leads qualified management and administrative personnel. Maintains continuous and open communication with the administrators regarding problems, ideas, suggestions and methods to improve quality of care. Terminates or transfers employees as needed, based on sound rationale and documentation, in collaboration with the human resource department.

Keeps governing body informed of center status, progress, needs problems, changes and projected changes on a regular basis. Supports and adheres to organizational policies and procedures, goals, and philosophy. Reports directly to the President of the company.

Administrator

April 2000 – August 2001

Responsibilities include ensure facility is adhering to all policies and procedures. Implementation of policies and procedures. Participate in the quality assurance program for client care and staff performance. Ensure that all personnel are assigned duties based upon their education training competencies and job description. Ensure the provision of staff orientation and staff education.

Direct workflow to staff, allowing them to execute their responsibilities successfully. Supervise the provision of medical services. Conduct employee evaluations. Report directly to the Vice President of Operations.

Dignified Home Health Care LLC

420 North Broad Street

Elizabeth, New Jersey

Owner

January 2007 – August 2014

Established a Home Health Care to include policies and procedures. Responsibilities include complete oversight of the Home Care agency. Maintain Compliance with Commission on Accreditation of Home Care and JACHO. Oversight of coordination of services. Investigate complaints and ensures problem resolution and correction of deficiency. Ensures and provides employee counseling, coaching, and progressive discipline as needed. Provides ongoing feedback to employees concerning performance and maintains proper documentation. Planning for, and administration of, the managerial, operation, fiscal and reporting mechanism of the Home Care agency. Establish contracts with all Medicaid HMO’s. Develop and implement policies and procedures to meet compliance with all regulatory entities.

NURSEFINDERS

HealthCare Services

Verona, New Jersey

Branch Director

1998 – 2000

Responsibilities include the planning of business strategy, direct staff and implement policies. Serve as an office controller. Participate in the preparation of site for JCAHO and C.A.H.C. Determine community health needs through consultations with healthcare facilities, homecare agencies, and other clients. Participate in sales / marketing program, work closely with the Board of Directors and Professional Advisory Committee to achieve effective management, well-planned programs, staff and program development, and thorough program evaluation.

UNION COUNTY COLLEGE

Elizabeth, New Jersey

1994 - 1998

Theory/Clinical Instructor

Responsible for teaching Fundamentals of Nursing to first semester students. Including, basic nursing skills, legal aspects of nursing, therapeutic communication skills, essentials of pharmacology, clinical instructor for psychiatric nursing and medical surgical nursing, pediatrics and obstetrics.

Follow the curriculum and assist in development.

Also, responsible for teaching pediatrics and obstetrics to senior students.

CURAFLEX HOME INFUSION SERVICES

Scotch Plains, New Jersey

1993 - 1994

Nurse Clinician/Nursing Supervisor

Senior staff member and first resource person for the company responsible for initial assessment to determine the physical, emotional and mental status of patients at home diagnosed with Lymes Disease, Cancer, HIV, Osteomyelitis, etc. Instruct patients in English and Spanish on how to independently manage their home infusion therapy using manuals and demonstrations. Visit patients’ weekly, monitor lab results, and handle blood draws as per physician orders. Provide 24 hours on call service for pharmacy and nursing. Designed, developed and implemented policies for nursing department to comply with OSHA guidelines regarding laboratory specimens. Train new nurses on use of long line catheters, port/a/cath access, repair of Hickman catheters, and proper IV insertions. Monitor central line Quality Assurance for the company and assisted the company in gaining Joint Commission accreditation.

NEWARK BETH ISRAEL MEDICAL CENTER

201 Lyons Ave.

Newark New Jersey

June 1990 – August 1993

Registered Nurse

Responsible for patient care on a medical surgical nurse. Pre and post op surgical preparation Wound Care, medication administration, blood transfusion IV medication. Follow PCP orders, and participate in the quality assurance program.

Charge Nurse as needed, report directly to the nurse manager

Bilingual English/Spanish



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