Alina Gomez
RN, BSN
Tampa,FL
Summary
Experienced Case Manager skilled in managing high caseloads and delivering top-quality care. Excels in high-pressure settings, consistently identifying optimal resources and actions to meet patient needs and enhance quality of life. Healthcare Executive proven to deliver exemplary level of healthcare service delivery to patients. Coordinate admission and discharge of patients. Plan and implement strategies for developing improved health care management. Proven problem solver, excellent communicator. Strong organizational skills, superb understanding of data collection and performance metrics. Recognized for staff development leading to high performing teams.
Overview
28
28
Years of professional RN experience in various settings
Work History
Case Manager I
Centene
06.2022 - Current
- Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
- Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes
- Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
- Organized and detail-oriented with a strong work ethic.
Corporate Auditor/Utilization Mgmt.
ActiKare In Home Medical
Tampa, FL
03.2021 - 12.2022
- Assessed and audited the company Account Receivable and payroll systems, successfully obtained full reimbursement for claims from 2018 to current
- Experience with Medicaid, Medicare, HMO, VA Tricare, LTC, and private pay payers
- Assisted in the development of annual audit plans, ensuring thorough coverage of key business areas
- Evaluated the effectiveness of implemented corrective actions, ensuring alignment with regulatory requirements and best practices
- Utilized data analytics tools to identify patterns and anomalies within financial records, strengthening overall audit quality
- Maintained up-to-date knowledge of industry trends and changes in regulations, applying insights to enhance audit methodologies
Surveyor- Private Duty and Medicare/Medicaid Home Health
ACHC
01.2016 - 01.2018
- Applied systems analysis skills and inductive skills to determine health care organizations' degree of compliance with applicable standards and functionality of care delivery systems
- Engaged health care organization staff in interactive dialogues on standards-based issues in health care in order to assess compliance and to identify opportunities for improving compliance
- Prepared management reports that clearly link individual standards deficiencies with potential systems vulnerabilities and related organization risk points
- Effectively communicated this information to health care organization leadership in a constructive and collegial style
- Assisted in the development of a comprehensive risk assessment framework for evaluating potential threats to organizational compliance systems.
VP Operations:Administrator/Director of Clinical Practice and Founder
Reliant Home Health Care LLC
Clearwater, FL
01.2011 - 01.2016
- Proud co-owner of a self-financed, financially sound, no investors CHAP Medicare Provider for skilled Home Health Care needs for the Pinellas and Pasco counties; Hillsborough County separate Medicare Provider number
- Cultivated a high-performance culture within the organization by setting clear expectations for employees at all levels, providing regular feedback, and recognizing achievement
- Adaptable and proficient in learning new concepts quickly and efficiently.
- Demonstrated strong organizational and time management skills while managing multiple projects.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
Director of Professional Services
Brookdale Senior Living – Innovative Senior Care
Seminole, FL
01.2011 - 08.2013
- Clinical oversight, financial, team building, AHCA and Medicare compliance, census development within community and ILF/ALF settings
- Trainer for Florida Director of Professional Services and Corporate Liaison for special projects involving pay structure rollout, software implementation
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Learned and adapted quickly to new technology and software applications.
Regional Administrator/Chief Nursing Officer
Vitalcare Home Health
Tampa, Bradenton, Sarasota
01.2009 - 01.2011
- Responsible for total branch management including sales, personnel, recruiting, budgeting and P/L
- Assist with regional guidance for compliance, regulatory, supervision both clinically and agency wide focus
- Ensured compliance with company policies, industry regulations, and legal requirements across all regional operations
Administrator/Director of Clinical Services
Advanced Homecare Inc
Jacksonville, FL
01.2007 - 01.2009
- Responsible for total branch management including sales, personnel, recruiting, budgeting and P/L
- Started Agency with successful state, ACHC and Medicare deficiency free surveys
- Responsible for direction of all home health clinical services
- Establishes, implements and evaluates goals for providing home health services that support the mission and philosophy of the Agency
- Demonstrated ability to lead start up agency with supervision and direct clinical and administrative personnel.
Education
Legal Nurse Consultant Certification -
Bachelor of Science Nursing -
Associate Degree/nursing -
Associate of Arts -
Skills
- Skilled documentation
- Interpersonal skills, Interviewing technique
- Case Management
- Quality assurance and Auditing
- Organization and Multitasking
- Care Coordination and Advocacy
- Effective Communicator