Safety Officer Documentation Specialist
Resume:
ERWIN U. MACATULA, RN, BSN, MBA
**** ******** **. **, ** 90041
QUALIFICATIONS
Over 18-year experience in inpatient and outpatient care management, utilization review, discharge planning, case management, population care/health management, and managed care.
Over 13 years of leadership experience in managing ambulatory clinic with specialty in Allergy, Immunology, Dermatology, Mohs Surgery, Head and Neck, Ears Nose & Throat, Maxillofacial, Hematology & Oncology, Bone Marrow Transplant, Urgent Care & Emergency Department.
Over 12-year experience with EPIC, AllScripts, and Cerner Millennium. Over 10-year experience in developing & building work-flow processes and flow sheet via epic. Over 10-year experience in Epic and Cerner data analytics, exporting, importing, projection, trending, benchmarking, and all related functions.
EDUCATION
1997-1998 Associate Degree in Nursing, East Los Angeles College, Los Angeles, CA
2005-2007 Baccalaureate Degree in Nursing-Master Business Administration University of Phoenix, Pasadena, CA
PROUD ACCOMPLISHMENT:
Behavioral Health Program in collaboration with the Los Angeles Fire Department
Implemented a community-based program with the Los Angeles Fire Department
Providing an onsite BH interventions and treatments
Providing BH focus care, reducing delay in BH care
Reducing ED overutilization and reducing readmissions
Behavioral health diversion program to other community partners e.g. to a Psychiatric Facilities, clinics, BH Clinic, VA, etc.
Conducts BH follow-up visits to the patients’ home visits, virtual and telephonic
Well-Being Trust Program for Homeless Patients with Substance Abuse
Providing chemical dependency rehabilitation program
Renting 2 private homes to provide shelter while patients are undergoing therapy
Developed a Partnerships with the Federally Qualified Health Centers (FQHC)
Partnered with San Fernando Community Health Centers and Comprehensive Health Centers
Designed for patients without a primary care physicians
To help reduce care gaps on patients that don’t have or limited access to care
Care Collaboration with LA Care, Harbor Recuperative Care, Providence Holy Cross, and San Fernando Community Health Center
Collaborative program for the homeless to reduce health disparities, improve care coordination and drive treatment compliance.
Providing interim housing to minimize care gaps.
ADDITIONAL TRAINING
Completed professional training in leadership, Throughput & Lean Process at Kaiser Permanente and USC-Hospital Association of Southern California HASC 2013-2014
Black Belt in Process Improvement- Six Sigma and Lean Process with focus in managing access, improving service, quality care, and affordability.
Completed professional training in Title 22, The Joint Commission, HIPAA Compliance and Regulation, & CMS & State Regulation
Member of American Case Management Association (ACMA)- acquired current knowledge in Health Care Reform including Managed Care, CAL Medi-Connect, Coordinated Care Initiatives (CCI)
Completed HR Academy and Advance HR Academy
9 years Super User/Documentation Specialist and Work-flow Consultant Kaiser Permanente
Completed CERNER professional training in Medi-Analytics, Cerner PowerChart, MS4, AS400, Ensocare, eReferral
Certified Laser Safety Officer
WORK EXPERIENCE
Providence Health & Services
Holy Cross Medical Center
Director of Case Management, Social Services, Transfer Center, Clinical Documentation Improvement (CDI), Medical Transportation, Facey Capitated Members, & Inpatient Dialysis 12/2015- Present time
In-Patient Case Management, Managed Care, Ambulatory and In-Patient Social Workers, Transportation, Transfer Center and Community Benefits.
Managed Facey Medical Group Senior Capitated Members
Oversee CDI operation
Manages all the soft denials
Oversee 65+ Employees
Manage Finances for Case Management, Social Workers, Transfer Center, Transportation, Executive Health Resource, R1 Resource, Community Benefits, 340B Drug Accounts.
Managed over 5 Million Accounts Weekly
Expert in Interqual, 2 Midnight Rule, and determining Observation vs. In-patient Status/Criteria
Responsible for hiring, on boarding, competency validation, corrective action, and termination of employee/s
Proactive engagement with Revenue Cycle (HIM, PFS, & Patient Access) operations to minimize AR days, decrease denials, & improve TAT for revenue capture.
Proactive engagement with Ethics, Throughput, and UM Committees to minimize avoidable delays, reduce Medicare/MediCal readmission rate, & Length of Stay.
Provide physicians and staff education and training to help improve knowledge with discharge planning and utilizing resources.
Concurrent, prospective, & retrospective management of MD payroll, non-MD payroll, and non-payroll.
SKILLS
Over 10 years Super User/Documentation and Work-flow Consultant Specialist Kaiser Permanente, EPIC Health Connect In-patient and ambulatory, AllScripts EMR, Vizio, KITS, MainFrame, Lotus Notes, Windows XP, Microsoft Office XP, Word, Excel, Access, Power Point, PC and MAC Web design, Teletracking (TLC), Ensocare, InterQual, Cerner PowerChart, Cerner Millennium, MedeAnalytics, DataAnalytics2, AS400/MainFraime/MedSeries4
KAISER PERMANENTE, Los Angeles, Glendale, & Pasadena Medical Office
PROMOTED to a Clinical Director 2/2009 to 9/2015
Department of Case Management, Social Services, Transfer Center, Allergy, Immunology, Dermatology, Mohs Surgery, Population Health Management
Oversee 45 employees.
Develop itemize retrospective and prospective financial planning for MD payroll, non-MD payroll, and non-payroll.
Develop projection tool to help manage real time and prospective appointment supply and demand.
Participated in quality care service projects and created a quality service newsletter and news board.
Assess, develop, implement, and monitor action plan for access, service, affordability, and quality to meet local and federal requirements.
Conduct frequent educational presentations and research to improve patient care services for staff members and higher-level management.
Los Angeles Medical Center Laser Safety Officer.
Conduct daily, weekly, monthly, and annual audits for quality care measures and regulatory requirements.
Provide mentorship and professional support to ancillary staff and providers.
Conduct assessment and develop short term and long term plan for continuing education and in-service for ancillary support and providers.
Update and help maintain the acuity competency of the staff.
Supervise daily operation and coordinate staff scheduling.
Independently and collaboratively develop multiple departmental work-flow processes to help improve patient care services, quality of care, and affordability.
Involve in service expansion preparation in Pasadena and Glendale Medical Office Building.
Help operation in maintaining and optimizing dermatology residency and allergy fellowship program.
Manage employee performance, hiring, and termination of employment.
Co-manage Dermatology residency program and Allergy fellowship program
KAISER PERMANENTE, Los Angeles, CA
PROMOTED to a Supervisor Inpatient Case Manager 02/07- 02/09- Hematology, Oncology, and BMT, Ortho, Telemetry
Establish and coordinate treatment plan
Patient advocate and educator
Implementing interventions identified in the plan of care according to the treatment plan established by the inter-disciplinary health care team.
Observation and reporting of signs and symptoms of illness and reactions to treatments
Communication with medical insurance and IPA regarding treatment authorization
Utilization Review
Discharge Planning
KAISER PERMANENTE, Los Angeles, CA
PROMOTED to a Case Manager /Clinical Supervisor 5/06-2/07 Ears, Nose, Throat, Maxillofacial
Provide clinical and non-clinical support to more than 25 employees including receptionist, medical assistant, LVN, RN, PA, and case manager.
Accountable for daily clinic operation including staffing, staff assignments, managing time off, & payroll.
Accountable for staff competency training and evaluation
Provide personal and professional mentorship to staff members
Help resolve patient complaint
Accountable for medical equipment maintenance and ordering medical supplies
Accountable for new employee orientation, performance evaluation, coaching, and disciplinary action.
Accountable for developing and streamlining work-flow processes
Act as a liaison between the staff, physician, patient, etc
Accountable for any clinic related requirements for accreditation
Physician, staff, and patient advocate
Conducts daily huddle and regular meetings
Frequent clinic rounding
Triage nurse, advice nurse, message nurse
Accountable for maintaining clinic appointment access, providing quality patient services, and improving service affordability.
GLENDALE ADVENTIST MEDICAL CENTER, Glendale, CA
Charge RN 1998-2005
Emergency and Telemetry Department
DERMATOLOGY CLINIC, Pasadena Medical Office
Staff RN 1999-2005
SKILLS
EPIC Health Connect In-patient and ambulatory, AllScripts EMR, Vizio, KITS, MainFrame, Lotus Notes, Windows XP, Microsoft Office XP, Word, Excel, Access, Power Point, PC and MAC Web design, Teletracking (TLC), Ensocare, InterQual, Cerner PowerChart, Cerner Millennium, MedeAnalytics, DataAnalytics2, AS400/MainFraime/MedSeries4
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