Ana Baqueiro, BSN, RN, CCM

• Work directly with Patient Access Nurses, as well as supervise them in day-to-day operations to ensure facilitating patient medical and financial clearance using nursing knowledge, clinical judgment, and communication skills.
• Work directly with Bed Board Coordinators, as well as supervise them in daily regulation of hospital-wide bed availability through real-time monitoring of ED admissions, transfers, and discharges; thus facilitating effectual throughput and patient flow.
• Obtain authorizations from multiple insurance carriers for various levels of care for ED patients
• Perform clinical reviews of ED patients requiring hospital admission to determine whether criteria for medical necessity is met by using Milliman Guidelines.
• Communicate immediately to physicians and ED case managers when a patient is not meeting appropriate criteria, insurance requests patient transfer, or when authorization for admission is denied.
• Document complete and accurate communication with payors, physicians, and ED case managers,
• Perform annual employee evaluations, performance reviews, and provide coaching.
• Provide MCG training for new nurses.
• Facilitate hiring of qualified Patient Access personnel by interviewing applicants and making recommendations for employment.
• Establish and update work schedules to account for changing staff levels and expected workloads.
• Attend weekly leadership meetings.
• Performed duties in accordance with applicable standards, policies, and regulatory guidelines to promote a safe working environment.

Responsible for case management of all inpatients in Family Life Center (Women and Newborn Services Department: NICU, Nursery, L & D, Antepartum, & Postpartum) from admission through discharge. Accountable for cost-effective utilization and management of resources while maximizing quality care.

• Consulted and coordinated with an interdisciplinary team (physicians, nurses, social workers) to ensure patient needs were met safely and effectively.
• Arranged discharge planning for patients requiring home health, durable medical equipment, or home infusion.
• Responded promptly and professionally to patient questions and concerns.
• Determined patient status (observation versus inpatient) to justify admission, continued stay, or discharge using Milliman criteria.
• Completed daily utilization reviews to obtain payer authorizations.
• Managed length of stay and facilitated movement of patients to appropriate levels of care.

Assumed a leadership role in the assessment, development, implementation, and outcomes evaluation of admissions and discharges in the Family Life Center.

• Assessed patient flow and throughput on all units, focusing on timely admissions and discharges.
• Provided follow-up and data to case management and OB areas for performance improvement.

Managed care from admission to discharge for patients having outpatient surgical procedures.

• Prepared patients for surgery, educating patients and family members on procedures such as breast augmentation, liposuction, and rhinoplasty.
• Managed care for post-operative patients from initial recovery through discharge.
• Responsible for counting all surgical instruments and sponges during surgeries.

Provided direct patient care. in acute and ambulatory care settings such as:

• St. Mary's Medical Center, Long Beach (NST Clinic)
• UCI Medical Center, Irvine (Outpatient Surgery/PACU)
• United Surgery Center, North Hollywood (GI Clinic)

Worked as a Traveler/Registry RN at various facilities including:

• Kaiser Hospital, Panorama City
• Kaiser Hospital, Los Angeles
• Huntington Memorial Hospital, Pasadena
• Olive View Medical Center, Sylmar

• Charge nurse for L & D and postpartum.
• Preceptor for new nurses.
• Worked in the Fetal Testing Clinic.

• Performed direct patient care of antepartum, intrapartum, and immediate postpartum care of high-risk obstetrical patients.