PO BOX ****
Hidalgo, TX 78557
SSN: XXX-XX-6844 Military Status: USN, 10/88-Present US Navy Reserve. US Navy Chief. E-7
Citizenship: U.S. Veteran’s Preference: 30 Points
Civilian Status: Utilization Review Nurse Managed/Care Coordinator, clinical instructor RN and LVN program.
Clearance: Secret (adjudicated October 2010).
Obtain a position where my education, military experience, and past supervisory experience may be utilized to enhance patient care, achieve company goal, and increase efficiency.
Current student University of Texas-Arlington Advance Practice Nurse, Family Nurse Practitioner program.
Graduate Chamberlain College of Nursing, Bachelor in Science of Nursing.
Graduate Lamar State College- Port Arthur Nursing School Associates Degree in Nursing Science.
Enrolled Excelsior College School of Health Care Management MBA program.
Attended University of TX-Pan American. Edinburg, TX (94-96).
Attended University of Maryland, European Campus. Sigonella, Italy (90-92).
Naval School of Health Sciences, San Diego, Ca. 1989
Training and Licenses:
Current Nursing RN License State of Texas.
Current Nursing LVN License State of Texas.
Current Peace Officer License State of Texas.
Certified National EMT.
Rio Grande Valley College School of Nursing April to present:
Current serving as clinical instructor for LVN/LPN and Registered Nurse students. Primary trauma and medical surgical instructor. Clinical instructor for hospital medical surgical rotation. Adjunct instructor for pediatrics and obstetrics clinical rotation.
United Health Group January 2019-April 2019:
Provided education and training to provider medical group and practice in regard to clinical coding as sr. nurse consultant and help identify consistent, efficient processes and help implement and share best practices in a collaborative effort with providers and nursing team in Rio Grande Valley market. Work was performed in hospital and clinic facilities and help and achieve and goals set for HCC Ratio, and coverage increasing patient access and improving healthcare outcomes and compliance according to Medicare policies and procedures.
Superior Health Plans 2012-2019:
Utilization Review Nurse Managed/Care Coordinator: Case manager for superior health plans. Promote compliance with federal and state Medicaid regulations. Develop, implement, and maintain compliance with policies and procedures medical management cases. Develop, implement the use of appropriate medical resources. Facilitate on going communication between case management staff and utilization review managers. Oversee operations of the referral management, telephonic utilization review, prior authorization functions, and case management programs. Ensure compliance government and contractual guidelines and the mission, philosophy and objectives of Corporate and the health plan. Clinical Assessments sent to Medicare and Medicaid. Daily Census, Care Planning on all admissions. Weekly Rehab and concurrent review meetings with Rehab and Clinical Team (IDT) discussed discharges, patient progression and possible extensions. Pre-Authorization prior to admission and appeals process, Notice of Medicare Non- Coverage Letter, obtain pre-authorization for special procedures and medication such as carve outs. Utilization of ICD-9 and ICD-10 codes.
US Navy 2011
Senior clinical supervisor US Naval Hospitals and operational clinics at Camp Leatherneck Afghanistan. Supervised, directed, and coordinated clinic and hospital medevac operations in a combat zone. Maintained outlying clinics and medical personnel in compliance with American medical regulations. Worked closely with medical director with developing standard operating procedures for day to day clinic operations. Developed medical and nursing outreach program for local Afghan population. Provided medical and nursing training to American and Afghan forces.
Carestat Home Health Agency 2008-2010:
Home Health. Staff Nurse Duties included administration of IV medication (including port a cath, picc lines, and central lines), oral medications, and Topical medications. Transcribe verbal and written MD orders. Provide discharge teaching to patients with chronic illness such as: Diabetes, cancer, and chronic wounds. Monitor vital signs and provide advance wound care such as management of wound vaccs. Supervised licensed and unlicensed personnel. Provide prescribed medical treatment and personal care services to ill, injured, convalescent, and handicapped persons in private homes: Take and record patients' vital signs. Provide wound care, enemas, douches, alcohol rubs, and massages. Apply compresses, ice bags, and hot water bottles. Observe patients and report adverse reactions to medication or treatment to medical personnel in charge. Administer specified medication, orally or by subcutaneous or intramuscular injection, and note time and amount on patients' charts. Assemble and use such equipment as catheters, tracheotomy tubes, and oxygen suppliers. Collect samples, such as urine, blood, and sputum, from patients for testing. Record food and fluid intake and output. Bathe, dress, and assist patients in walking and turning. Record information into designated medical records.
US Navy 2007:
Deployed to Iraq with special operations support helicopter squadron. Provided ground forces with immediate advanced trauma, burn, and cardiac life support to military and civilian personnel. Provided trauma support during execution of direct combat action in urban environment. Provided trauma support in Air Force theater hospital to civilian and military personnel. Supervised and trained 10 subordinate personnel in trauma department. Maintained 248 medical records on 94.5 % medical readiness on squadron personnel.
Arthritis and Osteoporosis Centers 2004-2006:
Clinical administrator/coordinator for Rheumatology group: Arthritis and Osteoporosis Centers of Edinburg, Brownsville, and San Antonio offices. Supervised and trained 58 personnel on day to day clinical operations. Coordinated all of clinic operations activities including assessment, discharge planning, and contractors. Facilitated clinical training for medical providers and nursing personnel and managed quarterly training hours and budget. Supervised compliance with federal, state Medicaid and Medicare guidelines.
Rio Grande Regional Hospital, McAllen, TX. 1999-2004:
LVN Staff Nurse Telemetry unit. Duties included administration of IV medication (including port a cath, picc lines, and central lines), oral medications, and topical medications. Transcribe verbal and written MD orders. Provide discharge teaching to patients with chronic illness such as: Diabetes, cancer, and chronic wounds. Monitor vital signs and provide advance wound care such as management of wound vaccs. Supervised licensed and unlicensed personnel.
Johnny Llanes RN, APRN, FNP 956-***-****
Angie De Leon RN, BSN 956-***-****
Diana Cuellar LVN 956-***-****
Marc Gonzalez RN, BSN 956-***-****
Juan Gonzalez Administrator TX MHMR 956-***-****