BSN, RN, CNN

REMEDIOS R TABANGCURA, BSN, RN, CNN

PO BOX ******

STOCKTON, CA 95269-0069

209-***-**** ************@*****.***

CAREER OBJECTIVE:

Dedicated professional with proven performance in management, leadership and interpersonal skills, with over fifty years of combined clinical experience in Operating Room, Emergency Room, Mobile Intensive Care Nursing, Public Health Nursing, Case Management, Dialysis ownership and management of multiple Dialysis Centers, Director of Nursing in Skilled Nursing Facility and Long Term Care, Home Health Agency Director of Nursing and Patient Care Services, RN Manager of Clinical Practice and RN Clinical Manager; aiming to leverage my abilities to successfully fill the RN position at your company and ready to make an immediate contribution.

SKILLS:

Skilled Nursing and Long-Term Care Medicare Regulation and Compliance, PDPM

Home Health Medicare Regulation and Compliance, Electronic Visit Verification, PDGM

Quality Assurance, Quality Improvement

Infection Control/Prevention, Covid Infection/Surveillance, Contact Isolation, Enhanced Barrier Precaution measures/Implementation

Leadership and Guidance, Team Supervision, Multidisciplinary Team Collaboration

Staff hiring, orientation and training, Performance Evaluations and Performance Management

Patient Care Assessment and Treatments, Chronic Disease Management, Staff Development and Continuing Education/In-services

Case Management, HIPAA Guidelines, Privacy Act, Confidentiality of EHR, State Surveys Participation and Plan of Correction

OSHA Compliance, Injury Illness Prevention, Hazardous Material Management, SDS, Right-to-Know Information

ICD-10 Coding, Oasis Assessment Documentation, Individualized Plan of Care Development

Devero/Netsmart, Data Soft Logic, WellSky, Matrix Care, HCHB, Point Click Care EMR

Extensive knowledge on developing, writing and implementing Operational and Clinical Policies and Procedures in Dialysis and Home Health Care Operations

Hemodialysis and Peritoneal Dialysis Instructor

Credentialing and Contracting with Insurance Companies to be a provider of Dialysis services, and Home Health services.

EXPERIENCE:

DIRECTOR OF NURSING: Stockton Nursing Center, Stockton, CA

February 19, 2024- December 23, 2024

Collaborate with other departments within the facility to ensure quality patient care, smooth operations and timely completion of all tasks.

Attend and conduct Stand-up meetings with medical and nursing staff, administration and other department managers to discuss issues related to patient care delivery systems and other issues impacting day to day functions and activities of each department directly or indirectly affecting positive patient outcomes.

Provide leadership and direction to nursing personnel; identifies areas of improvement and provides continuing guidance.

Work closely with State surveyors during their visits to investigate complaints, grievances and filed SOC 341, after 5-day investigations are completed and submitted by Executive Director/Administrator.

Collaborate with Infection Preventionist Nurse on infection control, surveillance, prevention, implementation of policies on contact isolation or enhanced barrier precaution measures of different illnesses, including but not limited to Covid, MRSA, VRE, MDRO, ESBL and other identified conditions requiring isolation measures.

Advocate for Antibiotic Stewardship, ensure all prescribed antibiotics meet McGeer or Loebs criteria for treatment of infections such as UTIs.

Close collaboration with Director of Staff Development and participate in staff in-service and staff education for all Licensed Nurses and Certified Nursing Assistants.

Quality Assurance and Quality Improvement for continuing evaluations of quality-of-care provision within Medicare guidelines, to ensure State Survey readiness.

Reviews weekly weights with Dietary supervisor and RD, ensure proper diet for all patients and identify areas of concern, ensure patients are properly nourished with a well-balanced diet as ordered including snacks, G-Tube feedings, hydration.

Work closely with Wound/treatment nurse and Wound Dr on proper wound treatments for wound healing and prevention of acquired pressure injuries.

Coordinated and collaborated with Pharmacy consultants and Psychiatrist on use of psychotropic medications and gradual dose reduction through proper documentation of behavior manifestations per physician orders.

Ensure implementation of company clinical policy/procedures.

RN CLINICAL MANAGER: Center Well Home Health, Stockton, CA

December 5, 2023- February 5, 2024

Reviewed Clinicians’ clinical documentation in Home Care Home Base Electronic Medical Record, provided suggestions on specific areas of improvement to ensure compliance with Medicare regulations on the provision of Skilled Home Health Services.

Conducted Patient Care Conferences to review the need for Recertification when Home Health Goals established at start of care have not been achieved, corroborate with Clinicians on making sure there is medical justification to continue home Health services, or Discharge decision when all home Health goals have been achieved within or at the end of the episode.

Contacted Physicians for orders or order clarification, document in Coordination Notes in a timely manner.

Educated Clinicians on wound care treatment and dressing changes in accordance with the established Individualized Plan of Care.

Attended daily Stand-Up meetings with Area Directors regarding status of referrals, Intake and readiness for Start of Care, Recertification, Resumption or patient Discharge.

DIRECTOR OF NURSING SERVICES: Wagner Heights Nursing and Rehab Center, Stockton, CA

May 2023-Nov 2023

Collaborated with other departments within the facility to ensure quality patient care, smooth operations and timely completion of all tasks.

Attended and conducted meetings with medical and nursing staff, administration and other department managers to discuss issues related to patient care delivery systems and other issues impacting day-to-day functions and activities of each department directly or indirectly affecting positive patient outcomes.

Provided leadership and direction to nursing personnel; identified areas of improvement and provided continuing guidance.

Coordinated and collaborated with Pharmacy Consultant on use of psychotropic medications and gradual dose reduction through proper documentation of behavior manifestations per physician orders.

Coordinated with State surveyors during their visits for a short and full survey of facility and participated in writing Plan of Corrections with Executive Director/Administrator.

Collaborated with Infection Preventionist Nurse on infection control/prevention and surveillance, making sure isolation procedures are implemented accordingly.

Conducted QAPI meetings and tracked areas of concern needing improvements, finding solutions, implementing solutions accordingly.

Conducted nursing staff performance evaluations, performance management accordingly.

Implemented all company clinical policy/procedures.

DIRECTOR OF NURSING AND PATIENT CARE SERVICES: Emerald Health and Wellness, Stockton, CA September 2020-April 2023

Consultant for two years while preparing this new home health agency for an initial certification survey.

Collaborated with ACHC surveyor during an initial survey of agency, followed clinicians in the field during home visits, wrote a plan of corrections and successfully obtained Medicare and Medi-Cal certifications before accepting patients for home health services.

Identified areas for improvement based on feedback from patients, families, caregivers, and representative payees through patient satisfaction surveys conducted on every admission and discharge.

Performed staff evaluation and performance management accordingly.

Ensured compliance with applicable regulations while maintaining high ethical standards of care.

Worked effectively with physicians, nurses, and other members of the interdisciplinary team to coordinate patient care activities.

Supervised and evaluated work activities of all nursing clinicians by conducting unannounced home visits to observe clinicians' performance.

Responsible for overall home health services to include but not limited to patient care and treatments, referrals/intake, reviewed patients' medical records, physician orders for home health services, determined appropriateness and suitability for admission, assigned clinicians according to specific services per physician orders.

Made sure that Face to Face required documentation was received from the certifying physician or licensed practitioner, signed and dated within the required time frame.

Performed admission assessments, recertification, resumptions and discharges utilizing the OASIS documentation, ICD-10 Coding, developed individualized care plans, coordinated with physicians on obtaining orders, made sure orders are carried out timely and accurately by corresponding clinicians, timely charting and documentation, and submission of records according to Federal and State regulations.

Provided new staff orientation and training, staff development with in-services, including CHHA monthly in-services required by regulations, conducted staff meetings, interdisciplinary QAPI meetings, discussed solutions for improvement, implemented and made sure of sustainability.

Conducted monthly patient care conferences, reviewed and updated individualized plan of care, made sure it is followed and implemented to achieve set goals.

Responsible for infection control/prevention, surveillance, including Covid, monitored and tracked incidence of infections, re-hospitalizations, and analyzed findings to improve patient outcomes.

Performed medical records audit, maintained privacy and confidentiality, observed and implemented HIPAA to protect confidentiality of protected health information.

Supplies inventory and ordering.

DIRECTOR OF NURSING AND PATIENT CARE SERVICES: Prestige Home Health Services, Inc

July 2015-March 2022

Responsible for overall home health services, intake, scheduling, medical records audit, new hire orientation and training, developed interdisciplinary individualized plan of care from admission to discharge when goals have been achieved.

Made sure that Face to Face required documentation was received from the certifying physician or licensed practitioner, signed and dated within the required time frame.

Coordinated all home health services with physicians and clinicians, developed, updated policies/procedures, conducted in-services for all staff, monthly specific in-services for CHHAs.

Performed staff evaluations and performance management.

Monitored and tracked quality measures and patient outcomes to identify areas for improvement to achieve high star ratings.

Conducted quarterly QA and CQI meetings, identified areas of improvement, developed and implemented IDT solutions and implementation, while ensuring sustainability evidenced by positive patient outcomes.

Implemented infection control, surveillance, and prevention.

Conducted annual emergency preparedness drills, conducted annual PAC meetings, maintained inventory and ordering supplies.

Trained and supervised all field clinicians on home visits and made sure policies/procedures on healthcare bag techniques, hand washing technique, patients' head to toe assessments, medication reviews and reconciliation, and home health teachings were provided and prepared patients for discharge once goals are achieved.

Ensured that the company was always ready and prepared for JCAHO surveys.

Performed Admission assessments, recertification, resumptions and discharges utilizing the OASIS documentation form and ICD 10 coding, obtained and carried out physician orders.

Trained new RN hires on OASIS documentation, completion and timely submission per CMS regulations.

Wrote plan of correction for JCAHO surveys, completed intra cycle monitoring.

CQI tracking on hospitalizations, CAUTI, HCAI, patient/employee incidents, results presented during quarterly QA meetings with Medical Director and IDT, presented solutions of improvements, implemented and evaluated efficacy and sustainability.

Annual review of all policy/procedures made sure business licenses, CLIA/waive testing certificates and Agency License are renewed before expiration, made sure employee files current per regulations.

Made sure OSHA regulations were followed, MSDS binder and Right to Know Information were posted available for all employees, monitored expiration dates for all equipment and supplies including recalled items, followed manufacturers' recommendations to ensure quality and patient safety including Fire Extinguisher annual preventive maintenance.

Participated in annual Governing Board meetings, conducted annual skills lab for all clinicians to ensure that all policies/procedures are followed accordingly to ensure clinicians' competency skills are maintained for the delivery of quality patient care, treatments and services.

RN MANAGER OF CLINICAL PRACTICE (MCP): Gentiva Home Health Services, Stockton, CA

October 2014-July 2015

Reviewed and analyzed health records for accuracy and completeness to ensure accurate billing processes were followed.

Reviewed clinicians' documentation and timely submission of clinical notes and OASIS documentation, to ensure that billing was done timely.

Conducted patient care conferences with all disciplines of care on all admissions, recertification, resumptions, and discharges to ensure that care plans developed are individualized and with concrete and reasonable goals to achieve before discharge.

Reviewed individualized care plans with medical justifications for any home health recertification.

Reviewed and supervised clinicians' knowledge on all types of wounds such as surgical, pressure injuries, diabetic ulcers, chronic wounds, osteomyelitis, gangrene, wound dehiscence, use of wound vacs, use of wound dressings specific to wound types and severity to ensure prompt wound healings.

Supervised clinicians during home visits to observe and monitor their competency skills on patient assessments, perform procedures and treatments including IV administrations, diabetic education and overall health teachings, observations of healthcare bag techniques, hand washing and hand hygiene compliance, medication reconciliation and patient/caregiver education on risks and benefits of all meds being taken, made sure that care plan is being followed and properly documented.

Contacted physicians to obtain or clarify orders and made sure orders are carried out timely, accurately and properly documented and signed timely by MDs.

Reported to the Branch Director all issues and concerns within area of coverage.

DIRECTOR OF NURSING AND PATIENT CARE SERVICES: Prestige Home Health Services, Inc, Stockton, CA July 2012-September 2014

Trained personnel on DSL and Devero EHR.

Patient Satisfaction surveys on all admissions and discharges to improve overall patient satisfaction regarding the delivery of Patient Care Services.

Established protocols for handling confidential information related to patients' medical records and histories.

Collaborated with healthcare providers to ensure quality standards were met in providing patient care services.

Created and managed training programs for staff on best practices in patient care services.

Provided direct patient care including medication management, symptom control, and health education and disease process.

Developed and implemented individualized care plans for clients to promote quality of life.

Maintained accurate records of client information, treatment plans, progress notes, discharge summaries, and medical histories.

Conducted home visits to observe and supervise field clinicians' performance, to evaluate patients' needs and develop appropriate service plans.

Coordinated multidisciplinary team meetings to discuss client progress and plan for future interventions.

Referred cases to social workers for complex psychosocial and economic needs.

Coordinated patient services with internal and external service providers through regular case conferencing.

Oversaw the recruitment, hiring, orientation, and training of new staff members in accordance with applicable laws and regulations.

Maintained communication between governing boards, medical staff, and department heads by attending board meetings and coordinating interdepartmental functioning.

Responsible for overall functioning of the agency on the delivery of patient care, treatment and services, educated and supervised office staff on intake processes and acceptance of referrals for admission, assigned clinicians according to physician orders for home health services.

Contacted physicians for obtaining orders, or clarification of orders, made sure orders were carried out timely, properly and accurately, signed timely by MDs, and documented in patients' electronic health record.

CLINICAL CARE COORDINATOR: DaVita Delta Sierra Dialysis Center, Stockton, CA

May 2011-November 2011

Actively participated in multidisciplinary rounds providing feedback on best practices.

Reviewed monthly lab results of dialysis patients, adjusted medication doses per protocol, submitted recommendations to all Nephrologists for further intervention and orders based on current clinical assessments.

Electronically entered patients' monthly progress notes, developed nursing care plans in conjunction with all IDT members including patients/families/representatives, then met monthly for patient care review and follow up care conferences.

Audited medical records of all admissions and discharges to ensure that State and Federal regulations on medical records keeping are strictly followed and that dialysis center always maintains survey-ready status.

Participated in facility audits utilizing Comprehensive Assessment Tool based on Title 22 V Tags of Federal and State Regulations in ESRD, discussed and wrote plan of correction for any deficiencies, made sure that plan of corrections is implemented and evaluated for sustainability and continuing compliance.

FACILITY ADMINISTRATOR/CO-OWNER: Delta Sierra Dialysis Center Inc, Stockton, CA

October 1995-April 2011

Coordinated with contracted Building Contractor on the design, blueprint and eventual building of the Dialysis Facility from groundbreaking to completion, application permits, building inspections while applying for the State License, Business License, City License, CLIA Waiver, DEA License, and culminated with the approval of Medicare and Medi-Cal Certification to provide dialysis treatments.

Developed, wrote and implemented Dialysis Operational Manual, Clinical and Employee Policies/Procedures.

Successfully managed the overall dialysis facility operations, including maintenance and repair of equipment, safety and security protocols, budgeting, and customer service.

Coordinated with vendors to ensure timely delivery of supplies at the lowest cost possible.

Maintained accurate records of inventory, contracts, personnel information, and other documents in accordance with company policy.

Prepared weekly schedules for staff members based on workload requirements of patient to staff ratio.

Maintained a safe working environment by adhering to safety policies and regulations.

Developed emergency response plans in the event of natural disasters or other unforeseen circumstances in coordination with local Office of Emergency Services.

Monitored budget expenditures related to facility operations and identified areas for cost savings initiatives.

Ensured compliance with local laws pertaining to health and safety standards within the workplace environment.

Negotiated contracts with vendors that provided Dialysis machines and related equipment, services or materials related to facility business management functions.

Developed plans for emergency preparedness training sessions for staff members regarding fire safety protocols in accordance with OSHA guidelines, Injury and Illness Prevention and right-to-know information.

Conducted hiring process, provided orientation and training, monthly in-services for staff development, performed staff evaluations and performance managements accordingly.

Fiscal and Financial responsibilities to include but not limited to payroll, accounts payable, accounts receivables, Medicare/Medi-Cal and private insurance billing, Insurance credentialing and contracting, obtaining Treatment Authorization Request (TAR) for straight Medi-Cal, insurance authorizations from private and managed care insurance patients.

Medical records safety and privacy by HIPAA regulations.

Transplant coordinator for facility.

Annual Medicare cost reports.

Annual Policy/Procedure review/updates to conform with CMS regulations.

Implementation of Life Safety Standards, monthly safety meetings, bi-annual fire drills, and annual emergency preparedness drills.

Annual community outreach provides a day of health education and presentation, providing public education on self-care, illness prevention and providing list of physicians with different specialties for those who didn't have a PCP.

Managed leasing of facility space until facility was bought out by Vivra Renal Care eventually became Davita Dialysis Company.

ASSISTANT VICE PRESIDENT NORTHWEST REGION: VIVRA Renal Care/DaVita Dialysis Company

Northern California to Portland, Oregon

March 1995-September 1995

Provided guidance to all Northwest region dialysis facility Administrators and Clinical Managers on regulatory issues impacting the organization's operations.

Developed and implemented strategic plans to increase operational efficiency and reduce costs within the Northwest region.

Generated reports summarizing monthly management activities of each dialysis center in the northwest region for executive review.

Provided leadership in developing corporate vision, mission, values, and culture.

Ensured compliance with applicable laws and regulations related to operations activities.

Established effective processes for monitoring operations performance against budget expectations.

Reviewed financial statements, sales reports, and other performance data to measure productivity.

Regularly visited seven ViVra/Davita dialysis facilities to ensure that CMS-mandated Clinical Outcomes were achieved and made sure that best practices in patient care are rendered and always maintained.

Fiscal and Financial management of these facilities to ensure profitability and achieve the expected bottom line.

FACILITY ADMINISTRATOR/CO-OWNER: San Joaquin Artificial Kidney Center Inc/Oak Valley Dialysis Center Inc, Stockton and Manteca, CA

April 1990-February 1995

Collaborated with external contractors to build both dialysis facilities within specified timelines including building permits and timely inspections, to ensure building codes are being followed.

Performed general administrative duties such as filing paperwork for dialysis facility license application, business license application, CLIA/Waive testing application for lab services, DEA certificate, making or answering telephone calls, and faxing or mailing correspondence accordingly.

Developed, wrote and implemented operational and clinical policies and procedures for general operation of facility.

Evaluated bids from vendors for goods and services necessary for facility operations then negotiated pricing and terms as appropriate.

Ensured compliance with local health and safety regulations in the workplace environment, developed plans for emergency preparedness training sessions for staff members regarding fire safety protocols in accordance with OSHA guidelines, MSDS and right-to-know information, hazardous material management, workman's compensation, disaster preparedness, violence in the workplace, conflict resolution, labor laws, and employer/employee postings updated yearly.

Conducted classes to teach procedures to staff, provided orientation and training, conducted staff evaluations, performance management and disciplinary action measures accordingly.

Developed, wrote and implemented specific dialysis policies/procedures, developed and wrote Dialysis Training Manual approved by the State of California Department of Health Services, subsequently obtained a Certified Hemodialysis Technician (CHT) training number which allowed our dialysis facility to train Patient Care Technicians and RNs, became certified Dialysis Technicians and Nephrology Nurses, resulted in adequate staffing of our dialysis facilities as we hired them after completion of required 400 hours of didactic and clinical experience and after passing the State Test administered by our dialysis center.

Developed and wrote a Dialysis Patient Information Manual which became a part of patient admission packet.

Implemented infection control, surveillance and infection prevention program, monitored, tracked incidence of recurrent patient febrile conditions during dialysis, caused by a non-tubercular mycobacterium avium, an antibiotic-resistant, water-borne bacteria found in non-treated water used in dialysis. This led me to find the flaw of our dialysis reverse osmosis water system, thereby structural changes to the pipes were made accordingly.

Made sure both facilities are survey-ready for any State visit, promptly wrote plan of correction for any deficiencies, implemented plan, and made sure of its sustainability with continued compliance.

Annual filing of Medicare cost report.

Billing and insurance contracting.

Annual emergency/disaster preparedness review and mock drills to ensure facilities' staff readiness in the event of disaster, signed and annually reviewed/renewed back-up agreements with other dialysis facilities to ensure continuity of patients' dialysis treatments in event of disaster.

Ordered supplies, kept adequate inventory, cost containment and price contracts with vendors.

Transplant coordinator for both facilities, identified candidates for kidney transplant, coordinated with transplant centers on evaluations and testings prior to being on the transplant list.

HEADNURSE/RN SUPERVISOR: Artificial Kidney Medical Clinic Inc, Stockton, CA

November 1978-March 1990

Managed and supervised a six-station dialysis facility, provided leadership and supervision of nursing staff, successfully managed workflow of day-to-day operations by utilizing effective problem-solving skills and performed direct patient care by initiating, monitoring and ending dialysis treatments per physician orders.

Demands for a larger facility was evident as more patients were diagnosed with ESRD requiring dialysis treatments to sustain life, therefore a need to add more stations to accommodate more patients; but under state regulations at that time, a Certificate of Need must be submitted and approved by the Office of State Health Planning and Development (OSHPAD) before more stations can be added. To obtain an approval, I conducted a study and researched on the population growth in San Joaquin County, and the incidence of kidney disease to determine the number of stations that can be approved by OSHPAD. Eventually, we were approved for 15 stations. This facility was the first independent, free-standing dialysis facility in San Joaquin County and privately owned by one Nephrologist.

Worked tirelessly to obtain our Medicare and Medi-Cal provider numbers as a dialysis provider. This was a wonderful opportunity for me to have paved the way to build three more dialysis facilities and became a co-owner of these facilities: San Joaquin Artificial Kidney Center, Oak Valley Dialysis Clinic and Delta Sierra Dialysis Center with Dr George Herron, Dr Lian Soung and Dr Jim Moshirnia.

Developed, wrote and implemented patient care Policy/Procedures, Employee Policy/Procedures, and staff development.

Developed, wrote and implemented hemodialysis operating manuals on the Redy Sorb machine, Cobe C2 Rx machine, Cobe C3 High Flux machine and the DRS4 Reprocessing artificial kidney machine in a way that streamlined their operation for staff training purposes.

Developed, wrote and implemented CAPD (Continuous Ambulatory Peritoneal Dialysis) training manual for peritoneal dialysis patients, trained and certified to perform own peritoneal dialysis at home.

Developed, wrote and implemented Dialysis Training Manual for Nurses and Dialysis Technicians and home hemodialysis patients who opted to train and perform their own hemodialysis treatments at home.

Developed, wrote and implemented artificial kidney reuse policy/procedure.

Provided orientation and training of new hires, conducted post training evaluations, annual performance evaluations, provided in-service education, annual fire drill, and emergency/disaster drills and entered into back-up agreements with the nearest dialysis facility located in Modesto, CA at that time.

Served as Transplant coordinator of the facility.

Conducted monthly grand rounds to review lab results with Nephrologists, patients and families who wanted to attend and participate on developing individualized patient care plans.

Implemented QA and CQI in all aspects of patient care, infection control, safety, personnel management and overall functioning and operation of the facility.

Trained nurses and dialysis technicians to perform acute dialysis at St Joseph's Hospital and Dameron Hospital, helped both hospitals in opening their own acute dialysis departments.

Ensured compliance with governmental regulations pertaining to the delivery of dialysis treatment services.

PUBLIC HEALTH CLINIC NURSE: San Joaquin Local Public Health District, Stockton, CA

October 1977-November 1978

Managed immunization programs for both adults and children.

Developed and maintained collaborative relationships with community to improve public

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