Case Manager Patient Advocate

DONNA VALENZUELA, RN

210-***-**** adxnxv@r.postjobfree.com

SUMMARY

• Highly skilled Healthcare Professional with extensive experience in Case Management, Intensive Care, Kidney Care, and Telemetry.

• Devoted Patient Advocate committed to providing quality care to patients and their families.

• Excellent communication and presentation skills – able to work effectively with physicians, hospital administration, nursing staff, patients, and family members.

− Exceptional interpersonal skills: able to manage emotionally charged environments and find solutions that meet the needs of patients in their most vulnerable moments.

• Flexible fast-learner who adapts quickly to new challenges, works well under pressure, and is accustomed to handling multiple ongoing tasks in a fast-paced and time-sensitive environment.

• Extensive computer skills include Microsoft Office Suite (Word, Excel, Access, and PowerPoint), Compass, OneNote, MS Teams, Availity, and EMR. HEALTHCARE EXPERIENCE

HEALTHMAP SOLUTION, San Antonio, Texas 5/21 – 6/22 CARE NAVIGATOR – (Remote position) provided world-class health care management for a company focused on progressive diseases, with particular expertise in kidney health populations.

• Completed activities for the continuum of care to facilitate and promote high quality, cost- effective outcomes for patients and focus on the whole patient and care delivery coordination.

− Managed a set caseload of mixed acuity members.

− Obtained member data and entered it into the HealthMap Care Management documentation system.

• Collaborated with internal and external (physicians, nurses, and other healthcare) personnel to assure positive patient outcomes and care coordination.

• Educated members on types of dialysis and transplant options.

• Served as a patient advocate for responding and working to resolve concerns and barriers.

• Utilized community resources and programs in care planning.

• Served as the liaison between the patient, the patient’s support network, treating physician, and other ancillary providers as a member of an interdisciplinary care team to coordinate care.

• Resolved nursing problems and assisted patients in meeting individualized goals.

• Complied with HIPAA privacy laws and all other federal, state, and local regulations. CONVIVA SOLUTIONS, San Antonio, Texas 3/11 – 2/21

CASE MANAGER – Established and maintained an excellent record of performance employing various strategies, approaches, and techniques to manage patient health issues.

• Identified and resolved barriers that hindered effective care.

− Ensured each patient progressed towards desired outcomes by continuously monitoring patient care through use of assessment, data, conversations with member, and active care planning.

− Served as a liaison between patients, their families, and health care personnel ensuring efficient healthcare services.

• Made decisions regarding work methods in ambiguous situations with minimal direction or guidance.

• Performed discharge planning and care coordination of Medicare Advantage patients.

− Reduced readmission rate by 28% by performing post discharge assessments on all assigned case patients.

• Volunteered to lead efforts to start up the company’s Dual Eligible Special Needs Plans (D- SNPs) and Chronic Condition Special Needs Plans (C-SNPs) programs.

− Led a 2-year project and brought the programs on-line, under budget, and on time. DONNA VALENZUELA, RN PAGE 2

HEALHCARE EXPERIENCE (Continued)

HUMANA, San Antonio, Texas 9/02 – 12/02 and 8/06 – 3/11 CASE MANAGER – Provided all aspects of onsite case management of commercial insurance and Medicare Advantage members.

• Accomplished pre-authorizations of care, inpatient authorizations, and conducted discharge planning including coordination of care and long term care management (disease and catastrophic care).

− Authorized inpatient services for care utilizing Milliman Robertson Criteria and InterQual.

• Analyzed and evaluated medical records and health data for hospital inpatients of various units to meet medical necessity determinations.

• Monitored and coordinated comprehensive plans of care and discharge plans.

• Coordinated with outside agencies to maintain a continuum of care.

• Educated patients and families on health care needs and available resources for unfunded clients.

• Selected to train and mentor new case managers.

ADDITIONAL EXPERIENCE

CASE MANAGER – Community First Health Plans, San Antonio, Texas HEALTHCARE FINDER – Foundation Health, San Antonio, Texas ASSISTANT NURSE MANAGER – St. Lukes Baptist Hospital, San Antonio, Texas REGISTERED NURSE CCU – Medical Center of Central Georgia, Macon, Georgia EDUCATION

Pursued a Bachelor of Science Degree in Liberal Arts, Macon Community College, Macon, Georgia

(completed 3 years)

Diploma in Nursing, Fairview Deaconess School of Nursing, Minneapolis, Minnesota Pre-Nursing Program, Augustana University, Sioux Falls, South Dakota Certifications and Licensure:

• Registered Nurse, State of Texas

• Case Manager Certification (Inactive)

• ACLS/BLS Certification (Inactive)

• ACLS, Instructor

Professional Development

• Motivational Interview Training

• Telemetry Rhythm Identification Training

• NCQA Standards Training

• InterQual Training

• Information Security Training

• Operational Security Training

• Diversity Training

• Conflict Resolution Training

• Supervisor Training

CIVIC AND PROFESSIONAL AFFILIATIONS

• Helotes Humane Society, Volunteer and First Aid Nurse

• San Antonio Flood Relief, Volunteer

• Brownies and Girl Scouts, Adult Leader

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