Toniell Rodriguez

***** ** ** ******* *****, FL *3173

786-***-****

adzyl4@r.postjobfree.com

Objective: To obtain a clinical ARNP position where I can use my knowledge and skills to ensure quality of care delivery for our patients.

Education

MSN, APRN, NP-C South University Savannah, GA Sept. 2019

RN, BSN, Barry University Miami Shores, FL. May 2010

Associate in Arts, (MDC) Miami, FL. May 2006

Experience:

DOCS Health March 2023-Present

oSupport Physical Health Assessments of military personnel.

oReview health history, service member medical records, and medical questionnaires.

oInterview military personnel to determine current and prior medical concerns.

oIdentify any concerns that need to be addressed immediately, inclusive of Behavioral Health.

oDocument interview results for readiness classification in the service member’s medical record. using the proprietary system.

oInitiate referral process to ancillary specialists including Behavioral Health.

Blue Cross and Blue Shield/Florida Blue Health Plan March 2023-Present

Dual Special Needs Sr. Manager

oResponsible for the day-to-day operations of the Medicare SNP department in conjunction with the Health Senior Director.

oAssure adherence to all corporate compliance standards, collaborate in the creation of the department policy & procedures, and ensure staff compliance with all protocols.

oSupport development and management of Care Management initiatives.

oWork collaboratively with other Care and Clinical Review programs, Enablement Team and other key stakeholders throughout the Enterprise.

oEnsure that Care Management Programs are implemented timely and consistently statewide with sufficient, appropriately trained resources.

oEnsure Care Management and Condition Care goals are being met. Create and analyze internal and external care coordination reports.

oMonitor and evaluate current processes and work in coordination with other Delivery System Programs to make improvements.

Blue Cross and Blue Shield/Florida Blue Health Plan July 2017- 03/2023

Dual Special Needs Plan Nurse Manager

oIn charge of providing new staff with onboarding orientation and program training

oAssist in the development, improvement, and oversight of the Case & Disease Management programs

oServes as the main liaison between the SNP department and the clinical PODS to ensure continuity of care for the SNP members and with the Quality team to focus on STARS/HEDIS initiatives related to admission rates

oAssist in the development, improvement, and oversight of the Complex Case Management programs

oResponsible for conducting ongoing internal mock audits for compliance and consistency with CMS regulatory requirements

oResponsible for the review and hiring process of new RN’s, Social Workers and Care Coordinators

oResponsible for building program structure around the Medication Therapy Management program (MTM)

oDesign and implementation of welcome call pilot to all new enrollees

oWorks alongside TOC Care Coordinator, SNP vendor, Case Management team and clinical PODS to appropriately identify and manage the most clinically complex high tiered members with high recidivism rates, frequent admissions, and frequent visits to the ED

oAssists with internal and external audits, including mock audits, CMS and AHCA audits, including prep work, staff training and audits and submissions to regulatory agencies

Coventry of Florida Health Plan/Aetna Health Plan May 2013-June 2017

Special Needs Plan Case & Disease Manager

oProvide telephonic Case & Disease Management to high tier members

oFocus on individual plan of care problems and interventions to obtain desired member outcomes

oEducate members of disease process, signs, and symptoms of possible complications and how to prevent ER visits and admissions

oProvider tele monitoring and disease management for members with diabetes, hypertension, and chronic heart failure

o Participate in Interdisciplinary Care Team conferences to discuss non-compliant, high-risk members with elevated utilization rates

oProvide complex case management for members with CHF, COPD, HTN, Diabetes and multiple ER visits and hospitalizations within a given quarter

Independent Living Systems (ILS) May 2011 -April 2013

Nurse Supervisor (Special Needs Plan- SNP)

oResponsible for creating, implementing, and overseeing the Post Discharge Program

oIn charge of reviewing clinical documentation and ensuring compliance with regulatory requirements

oResponsible for providing staff with client-specific training and process implementation

oWorked alongside the IT team to enhance the proprietary Case Management documentation system, E-Care

oResponsible for the direct oversight of the clinical and non-clinical case management teams

oFocused on documentation integrity, improvement and training

Clinical Case Manager (Special Needs Plan- SNP)

oInterdisciplinary care team nurse, responsible for the evaluation of post hospitalization cases to reduce patient admission, while enhancing patient comfort at home

oMedication Therapy Management (MTM) worked in conjunction with client pharmacy department to oversee utilization and compliance of medication adherence

oProvided members with medication teaching and reconciliation provided

oUtilization Management liaison, used effective relationship management, coordination of services, resource management, education, patient advocacy, and related interventions to promote improved quality of care and/or life

oPromoted cost effective medical outcomes

oPrevented hospitalization when possible and appropriate

Palmetto General Hospital. Hialeah, FL 2010- 2011

oEmergency Department Staff Nurse - Bedside Patient Care.

oPatient assessments and evaluations, medication administration, wound care dressings. Patient care plans and discharged planning.

Community activities:

oHelped organize and participated in a Walkathon to raise funds and awareness against domestic violence in partnership with Safe space Shelter for Women. (April 2010)

Skills

oBilingual in English and Spanish (Fluent)

oknowledge of (Microsoft Excel, Word, PowerPoint, Adobe PDF, Microsoft Outlook mail)

oComputer health management programs (e care Patient assessment, medication administration, and patient/family education.

Reference

oAvailable upon request

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