Patient Care Utilization Management
Resume:
CYNTHIA BESONG, MHA BSN RN
Walnut, CA
**************@*****.***
Summary
Retired Registered Nurse with a passion for patient care and helping others. With experience in direct patient care and management, I am committed to applying my knowledge and skills within the healthcare industry.
Work History
Director, Inpatient Quality Management
Kaiser Permanente, Baldwin Park
2000-2022
•Provides overall direction, design, development implementation and monitoring of utilization programs to meet the Medical Center's utilization goals while maintaining customer satisfaction.
•Acts as a resource to the medical staff, administrative staff, divisional, SCPMG, and external regulatory agencies in all issues relating to utilization management within the Medical Center.
•Analyzes and reports significant utilization trends, patterns, and impact to appropriate departmental and medical staff committees.
•Develops, monitors and controls department's budgets.
•Hires, coaches, trains and disciplines staff to ensure smooth operations in utilization management.
Provides leadership in redesign projects related to the coordination, design/redesign, delivery and management of nursing and patient care services.
Identifies methods and approaches to reduce cost structures and maintain high quality of patient care.
Provides expertise on subject matter addressed by project team.
Works with leadership and staff to implement programs.
Recommends project strategy, identifies best methods and processes, develops project planning, group process facilitation, training, and appropriate application of information technology. Collaborates with stakeholders and sponsors to define project charter, framework, vision, and deliverables. Ensures quality and effectiveness of research.
Monitors and maintains timelines and budget. Contracts with and manages work of internal/external consultants.
Coordinates all internal and external communication, represents the project to internal and external group.
Ensures the development of an effective implementation plan and facilitates the execution of this plan.
RN Case Manager
Kaiser Permanente, Baldwin Park
1999-2000
•Plans, develops, assesses and evaluates care provided to members.
•Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of appropriate, individualized plans of care to ensure continuity, quality and appropriate resource use.
•Develops and coordinates the implementation of a discharge plan to meet patient's identified needs.
•Reviews, monitors, evaluates and coordinates the patient's hospital stay to assure that all appropriate and essential services are delivered timely and efficiently.
•Conducts daily clinical reviews for utilization/quality management activities based on guidelines/standards for patients in a variety of settings, including outpatient, emergency room, inpatient and non-KFH facilities.
•Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred.
•Refers patients to community resources to meet post hospital needs.
•Coordinates transfer of patients to appropriate facilities; maintains and provides required documentation
RN Care Coordinator
Citrus Valley – Queen of the Valley Hospital
West Covina, CA
1996-1999
•Plans, develops, assesses and evaluates care of hospitalized patients.
•Develops and coordinates the implementation of a discharge plan to meet patient's identified needs.
•Communicates the plan to physicians, patient, family/caregivers, staff and appropriate community agencies
•Coordinates the interdisciplinary approach to providing continuity of care, including Utilization management, Transfer coordination, Discharge planning, and obtaining all authorizations/approvals as needed for outside services for patients/families.
Coronary Care Staff RN
Citrus Valley – Queen of the Valley Hospital
West Covina, CA
1990-1996
Managed total care of critical care patients in the acute setting
Intensive Care Unit Staff RN
Bay Harbor Medical Center
Lomita, CA
1982-1990
Managed total care of critical care patients in the acute setting
Professional Education
Bachelor of Science in Nursing
St. Paul College
Manila, Philippines
Master’s Degree in Health Administration
University of La Verne
La Verne, CA
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