Andrea M. Pascua
Huntington Beach,CA
Summary
Experienced Healthcare Professional in the Acute Care, Ambulatory, SNF and Hospice Care. Extensive background in case management, disease management, palliative care, discharge planning, utilization management and community resources. Clinical proficiency in performing thorough patient assessments and caring for a broad range of acute and chronically ill adults. Commitment to ensuring cost effective care while optimizing quality of care. Strong interpersonal and organizational skills, effective communicator with patients, families, physicians and healthcare professionals. Leadership skills in program development and training. Well versed in Medicare regulations, duals and managed cared.
Passionate about exploring areas in our healthcare system that would work with the interdisciplinary team to include palliative coordination, marketing, management and program development
Overview
25
25
years of professional experience
Work History
Provider Engagement Specialist
Alignment Healthcare
11.2023 - Current
- Develop collaborative relationships with key providers, provider office staff, and facilities to
Improve clinical program engagement and promote participation/partnership. - Support patient engagement activities, including program introduction, scheduling of follow up visits and communication of post discharge care coordination needs to ensure timely followup and prevent readmissions.
- Act as Alignment Health ACO subject matter expert for patients and providers/facilities.
- Conduct initial provider practice orientations and provide support for ongoing practice/facility engagement activities.
- Assist in the development of training and educational materials/tools. Create Provider in-service packets and implementation packets.
- Consistently and accurately utilize department databases and reporting systems to communicate quality performance status with appropriate provider partners to improve
practice performance. - Enhanced provider satisfaction by effectively addressing and resolving issues in a timely manner.
- Built strong relationships with providers through active listening and empathy, resulting in increased loyalty and retention.
- Collaborated with cross-functional teams to develop innovative strategies for improving provider engagement.
- Managed multiple projects simultaneously, ensuring deadlines were met and goals achieved.
- Assisted in developing marketing materials geared towards increasing provider engagement levels across various channels.
- Proactively identified potential challenges or roadblocks and devised strategies for overcoming them.
Hospice Liaison
Bristol Hospice
08.2022 - Current
- Communicates hospice services and benefits to patients, family members, and significant others in a manner that facilitates an accurate and positive view of hospice services.
- Works closely with community, hospital, and facility education representatives to meet growth and development targets and maintain market acceptance and allegiance.
- Provides education to hospitals and facilities on the purpose, process, and goal of hospice and palliative care. Collected and analyzed data and feedback to identify opportunities to improve relationship between other entities and business.
- Solved conflicts and addressed issues that occurred between other entities and business.
- Monitored, communicated and coordinated objectives and in-services.
- Liaised between internal departments and external partners to promote efficient communication and collaboration.
- Facilitated meetings and conferences between various parties, enabling better collaboration and efficient decision-making.
- Collected and analyzed data to identify trends and opportunities for improvement.
- Trained team personnel on liaison activities and protocols, mentoring and coaching to improve skills.
Acute Inpatient Case Manager / SNF Case Manager / Complex Case Manager Supervisor
Talbert Medical Group / Health Care Partners
02.2004 - 06.2014
- Responsible to coordinate all care/services and discharge planning for acute and chronically ill patients in the hospital and or SNF setting
- Implementing and coordinating interdisciplinary team conferences in hospital and SNF settting
- Initiating on site patient assessment and family meetings to discuss plan of care, discharge planning and long term planning
- Recognized for leadership in creating, implementing and teaching care plan documentation in the EMR system using Milliman and/or InterQual criteria
- Extensive disease management education with patient and family to include CHF, DM, ESRD, COPD and Coumadin Management
- Medication reconciliation at patient's bedside with patient and caregiver
- Piloting and implementing our post discharge clinic for all acute patients
- Identifying high risk patients for readmission, initiating 24hr post discharge phone call and follow up with physician and ambulatory case manager
- Indentifying quality cost effective outcomes and alternatives to acute care setting
- Initiate NONC's (notice of non coverage) in the acute care setting and SNF setting
- Responsible for over-site of Out of Network patients and determining if transfer to a contracted facility is appropriate medically and financially according to patients benefits and Health Plan DOFR's
- Claims Review of retro authorizations, utilizing ICD-9, CPT and HCPCS
- Review and authorizing high cost referral requests and determining medical necessary according to Medicare guidelines while identifying medical cost savings
- Department Liaison for implementation of Milliman Care Guidelines into our review process, responsible for arranging department meetings and coordinating training sessions
- Consult with Medical Director and other resources for assistance related to referrals, claims and medical necessity
- Super user for EPIC/Electronic Medical Records for Health Care Services Department, training staff on implementation of new computer software
- Kindred Health Care, Medicare Chart Audit
- Nurse Chart Audit for Acute Inpatient and Rehab, January 2004
- Per Diem weekend contract to review records and claims for medical necessity utilizing InterQual
Inpatient and Out of Network Case Manager
Prospect Medical Group
07.2001 - 02.2004
- Managing case load of 20-25 acute inpatient admissions in Orange County
- Reviewing all inpatient admissions with medical director for medical necessity and authorization of continued admission
- Case Management of catastrophic, transplant and complex patients to include referral authorization and care plans
- On-call 24hrs a day and weekends for out of network and out of area transfers to contracted facilities
- Coordinated all aspect of hospital transfer
- Utilization Review Nurse responsible to review referrals submitted by Primary Care Physicians and Specialists based on medical criteria and insurance benefits
- Responsible for managing Skilled Nursing Facility members to ensure appropriate utilization and skilled level of care
Licensed Vocational Nurse / Case Manager
Bristol Park Medical Group
08.1999 - 07.2001
- Receiving and processing patient referrals to specialty practices
- Communicating with patients regarding process of referrals
- Collaborating with Internal Medicine Physician on plan of care and disease management goals
- Verifying individual healthcare insurances and carve-outs to include HMO, PPO, POS, CCS, Medi-Cal and Cal Optima.
Education
Long Beach City College
Skills
- Microsoft Office (Outlook, Word, Excel, PPT, Access)
- Citrix Software
- EPIC / EMR Super User
- Touchworks
- IDX Software
- EZ Cap
- Knowledge of NCQA, CMS, HSAG
- Knowledge of coding, including ICD-9-CM, CPT, HCPCS, and medical terminology
- Health Pivots
- Trella Health - Healthcare Analytics
- Knowledge of current regulatory guidelines including Medicare, Medi-cal and Duals
Timeline
Provider Engagement Specialist
Alignment Healthcare
11.2023 - Current
Hospice Liaison
Bristol Hospice
08.2022 - Current
Acute Inpatient Case Manager / SNF Case Manager / Complex Case Manager Supervisor
Talbert Medical Group / Health Care Partners
02.2004 - 06.2014
Inpatient and Out of Network Case Manager
Prospect Medical Group
07.2001 - 02.2004
Licensed Vocational Nurse / Case Manager
Bristol Park Medical Group
08.1999 - 07.2001
Long Beach City College