PAOLA VELASCO

adwpbt@r.postjobfree.com 760-***-**** Imperial, CA. 92251

Summary

Reliable Manager demonstrating high level of ownership and initiative. Possessing exceptional work ethic and desire to go above and beyond to exceed company expectations. Offering knack for building productive working relationships. Successful in fast-paced, deadline-driven environments to manage goals and team development. History of thriving in team-oriented environments.

Skills

Customer Services

Speed Typing:

75 wpm

Organization

Time Management

Strong ability to manage multiple and complex task simultaneously

Able to lead small or large groups of people

Proficient in the use of MS word, Excel, Skype, OneNote, Power Point, Outlook, Teams, and MedEx.

Experienced in working with multiple counties within the state of California

Staff Development

Documentation and Reporting

Teamwork and Collaboration

Performance Tracking and Evaluation

Performance Evaluations

Team Leadership

MS Office

Experience

Medi-Cal Case Management El Centro, California

Manager

09/2021 - Current

REMOTE

Responsible for a group of 18 individuals with various titles from nurses, LVNs, to social workers

Manage the delivery of services to members, ensuring services are appropriate and cost effective

Ensure compliance with government and company requirements in the care management department

Develop and implement new procedures, regulatory filings and manage compliance issues

Develop, implement, and oversee care management policies and procedures and give specific guidance to staff and departments as appropriate

Develop, implement, and maintain care management programs to facilitate the use of appropriate services and resources in order to maintain the member in the least restrictive environment

Direct the daily activities of care management staff

Facilitate on-going communication between case management staff, members, contracted providers, and subsidiaries

Develop staff skills and competencies through training and experience

Manage resolution of complaints and assist in audits and evaluations related to our Medicaid population

If necessary, develop and implement corrective action plans

Hire, supervise and evaluate case management staff

Assist with job development

California Health and Wellness

California Health and Wellness El Centro, California

Senior Medi-Cal Case Manager II

09/2019 - 09/2021

REMOTE

Insurance- Case Management

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

Perform duties independently, demonstrating advanced understanding of complex care management principles

Participate in case management committees and work on special projects related to case management as needed

Case load will reflect heavier weighting of complex cases than Care Manager II, commensurate with experience

Serve as a subject matter expert for questions or issues for other Utilization Review and Care Managers, Referral Specialists and Program Coordinators

Audit case reviews to ensure compliance with case management policies and procedures and NCQA requirements

Assist with the development of case management workflows, policies, and procedures

Provide oversight to and assist with training of other case management staff

Medi El Centro, California

Cal Case Manager II

01/2018 - 09/2019

Insurance- case management of social, physical, and mental health needs

Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short- and long-term goals, treatment, and provider options

Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes

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

Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience

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

Direct care to participating network providers

Perform duties independently, demonstrating advanced understanding of complex care management principles

Participate in case management committees and work on special projects related to case management as needed

Spanish Certified

Molina Healthcare El Centro, California

Supervisor of Case Management

10/2016 - 01/2018

Responsible for ensuring that Case Management staff are working with client to develop care plans based on health needs

Hire, supervise and evaluate case management staff

Assist with job development

Work collaboratively with Community resources to meet clients needs

Analyze program data and plan for improvements

Submit monthly reports with quantitative and qualitative information

Review/Audit of Client files to ensure case management plans address identifies needs, are up-to-date and that quality is maintained

Coordinate staff and case management assignments

Attend program-related community, coalition and committee meetings

Mediate client grievances and facilitate case management/client issues

Molina Healthcare El Centro, California

Case Manager

02/2015 - 10/2016

Accomplish clients' care by assessing treatment needs

Educating and assisting members manage the health system

Developing, monitoring, and evaluating treatment plans and progress

Facilitating interdisciplinary approaches

Motivational Interview

Spanish Certified

Fresenius, Acute/Chronic El Centro, California

03/2011 - 01/2015

Building lifelong relationships through consistent, committed renal care

Creating custom care strategies with Fresenius' industry-leading, innovative renal treatment technologies

Working within comfortable, community-based clinics with optimal nurse-to-patient ratios

Sharing information with patients and families that answers questions and eases minds

Enjoying the rewards that come from treating the "whole" patient

Focusing on evidence-based practice and the highest safety standards

Growing and advancing in a supportive, developmental environment

Providing a special level of caring combined with advanced technology

ECRMC EL CENTRO REGIONAL MEDICAL CENTER El Centro, CA

Nurse Assistant

06/2009 - 08/2010

Managed care for adolescents, adults and elderly with wide variety of diagnosis such as diabetes, renal failure and cancer

Made appropriate interventions depending on patient's status and vital signs readings

Aid patients in their daily activities and documented all elements of a nurse assistant

Provide patient/family support Implement care for up to 12 patients at a time.

California Health and Wellness

Registered nurse

With 4 years of experience in the field of acute/chronic dialysis, along with 7 years in case management and 3 years' experience in leadership

Now seeking to work in a challenging leadership position by applying my creative problem solving and lean management skills with a growing company to achieve optimum utilization of its resources and maximum profits.

Education and Training

Grand Canyon University

Master in Nursing Administration

05/2019

Grand Canyon University

Bachelor of Science in Nursing

08/2013

Imperial Valley College

Associate in Nursing

06/2010

Languages

Bilingual (Spanish/English) Spanish Certified

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