Manager Nurse
Resume:
Giraldo Olivera
**********@*****.***
Objective: Willing to be part of an institution that enables me to practice and contribute towards common goals while using my resourceful and past acquired professional experiences.
Education: Master’s Science in Nursing, APRN-BC, South University 2017-September-2019
Bachelor of Science in Nursing, Barry University 2008-May 2010
Experience: Kendall South Medical Center ( FNP APRN, Family Practice) March 2020-Present
Providing primary care with annual wellness examinations and follow ups. Management of chronic illnesses. Clinical studies with imaging/laboratory interpretation with appropriate referrals. Health education and disease prevention. Telehealth and telephonic consultation.
Baptist Health South Florida (Utilization Review Nurse) December 2018-February 2020
Utilization Review: Review and evaluation of patients admission criteria for inpatient/observation level of care status while in the hospital. Collaborate with case management/social services to support patient care and discharge planning. Initial and concurrent review, using guidelines to support level of care criteria .
One at Home (Home Health Agency) November-December 2018
Provided patient care (RN eval and admissions, wound care, IV infusions, skilled nursing services)
Prestige Health Choice (AmeriHealth Caritas) (Prior-Auth Reviewer). March 2015-Oct 2018
Prior Authorization review of patient clinical information to find medical necessity of outpatient and elective inpatient procedures using INTERQUAL criteria. Assistant review coordinator for transplant and special need cases. Team lead in specialty pharmacy utilization review, specializing in oncology, pediatric and pain management. Collaborate with case management, social services and medical team to help co-manage patients’ medical necessities.
Compassionate Care Hospice: (RN Case manager) May 2014-March 2015 RN (Case manager) in charge of admissions, continuous evaluation of patients receiving hospice services with coordination of end life support and palliative care. Home visits.
Simply Healthcare Plans. (RN Disease Case Manager) June 2013- April 2014
-Disease Management: Lead nurse working with Medicaid/Medicare population targeting members with diabetes. Assessing and implementing plan of care for Post-Discharge members and timely follow ups.
-Transition of care: Catastrophic/High risks cases. Conducting home visits after hospital discharge or as needed to assist with coordination of services promoting patient compliance to help reduce hospital readmissions. Coordination of health services.
Preferred Care Partners. (RN Complex Case Manager) February 2011-June 2013
-HMO Medicare SNP (Special Needs Program) population.-CCIP (Chronic Care Improvement Program).
-Lead Nurse in Medicaid Disease Management Programs (Diabetes, Hypertension, HIV, Asthma, and CHF). Managing, supervision and completion of the Medicaid population initiatives to ensure compliance with ACHA guidelines. Weekly reporting
-Medication Therapy Management (MTM) Lead nurse working in conjunction with the pharmacy department to oversee utilization and compliance of medication adherence. Medication teaching and reconciliation provided.
-Opioid Overutilization Program. Monthly reporting and overview of opioid medications usage.
Skills -Advanced knowledge of (Microsoft Excel, Word, PowerPoint, Adobe PDF, Microsoft Outlook and Worldclient email)
-Computer health management programs (Facets, Laserfiche, Clinical Care Advance, Right Fax, Warm Health, QNXT, TriZetto, CPC Mumms, Jiva, Cerner, Sorian Financial, Interqual, Milliman, Practice Fusion EHR)
-Computer skilled, managing heavy daily patient volume. Proficient in all documentation/record maintenance/paperwork to ensure accuracy and patient confidentiality.
-Patient care
-Telehealth consulting with Doximity
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