Betzaida Santana
Largo,FL
Overview
21
21
years of professional experience
7
7
years of post-secondary education
Work History
RN Case Manager
HCA Largo Medical Center
12.2024 - Current
- Coordinate the patient’s plan of care throughout their hospital stay, actively managing the length of stay and ensuring efficient use of resources while developing a safe and appropriate discharge plan.
- Facilitate care progression and transitions across levels of care, identifying patients at risk for adverse outcomes during transitions and implementing strategies to mitigate those risks.
- Conduct comprehensive assessments of patients’ psychosocial, medical, and discharge needs, including evaluation of available and appropriate resources for patients and families. Reassess clinical status as needed to support care planning.
- Collaborate with Social Services to ensure post-acute medical needs and levels of care are appropriate and aligned with patient goals and clinical requirements.
- Monitor care progression using evidence-based tools and established criteria (e.g., InterQual) throughout the care episode, and escalate any barriers to care progression or transition as necessary.
- Initiate timely referrals to third-party payers, disease management, and case management programs for patients with chronic conditions or frequent admissions.
- Managed support services and fostered communication among social workers, therapists, hospital staff, and patients.
Case Manager Supervisor
Humana
10.2020 - 08.2022
- Ensure Compliance: Vigilantly uphold adherence to organizational policies and procedures.
- Performance Evaluation: Assess and enhance the engagement and performance of nursing staff.
- Report Preparation: Compile and present reports for upper management, offering insights and recommendations.
- Assignment Management: Review daily assignments and allocate tasks efficiently to ensure timely completion of daily production goals.
- Recruitment and Training: Spearhead the recruitment process, conduct interviews, and provide training to maintain adequate staffing levels aligned with organizational demands.
- Time Management: Review and approve timesheets promptly, ensuring accuracy and compliance.
- Team Leadership: Coordinate and lead bimonthly team meetings, fostering a collaborative and productive work environment.
- Metrics Oversight: Utilized metrics oversight to identify high-performing employees exceeding required duties and those not meeting organizational expectations, even predating my role as their supervisor.
- Result: Improved recruitment and training strategies, leading to a 20% increase in productivity among underperforming employees within the first year.
- Participation in Leadership Meetings: Actively contribute to organizational ICT/leader meetings, providing valuable input and insights.
- Employee Development: Organize and lead monthly meetings to address findings, identify barriers, and collaboratively create action plans for continuous improvement.
RN Case Manager
Humana
02.2019 - 10.2020
- Conduct daily assessments, leveraging clinical tools and data, to comprehensively evaluate patient needs and requirements.
- Create individualized and comprehensive case management and treatment plans, tailored to meet the specific needs of each patient.
- Determine insurance eligibility for various treatments and treatment programs, ensuring optimal financial coverage for patients.
- Clearly explain the rationale behind prescribed treatments and treatment plans to patients, fostering understanding and cooperation.
- Educate patients on their diagnosis, empowering them with the knowledge to actively manage their care and apply measurable lifelong goals for sustained well-being.
- Proactively seek benefits within the insurance policy that will be free of cost for the member, enhancing the probability of compliance and treatment adherence.
- Discuss current treatment plans with physician and recommend actionable adjustments to improve care or resource utilization.
- Monitored and documented patient outcomes to evaluate effectiveness of case management interventions.
- Document complex medical information accurately, outlining and improving health results for ongoing case management.
- · Follow case and quality management processes in strict compliance with regulatory guidelines and company procedures.
- Discuss current treatment plans with physician and recommend actionable adjustments to improve care or resource utilization.
- Referred patients to appropriate specialists or support services based on their unique circumstances.
- Participated in interdisciplinary team meetings to discuss complex cases and develop coordinated care strategies.
- Researched medical and community resources for chronic disease patients, including individuals diagnosed with HIV, CKD, cancer, spinal cord injuries, and/or homelessness.
RN Case Manager
Audie L Murphy VA Hospital
07.2017 - 02.2019
- Established a novel process within the cardiology department, contributing to enhanced efficiency and improved patient care.
- Integrated case management into cardiology huddles and rounds, becoming an essential member of the cardiology team.
- Collaborated with the cardiology utilization management nurse to identify trends in patients not meeting criteria; developed action plans for top reason codes, including CHF, HTN Emergencies, and unstable angina cases.
- Provided attending physicians with data on identified barriers and recommended action plans for early discharge planning.
- Coordinated care, anticipated barriers, and developed preemptive plans to reduce readmission and length of stay.
- Applied basic knowledge in the entry of InterQual/McKesson admission, continued stays, and discharge reviews.
- Assisted utilization management in data entry as applicable.
- Conducted interdisciplinary team discussions to promote the right level of care for patients not meeting criteria.
- Completed initial bedside interviews, addressing therapeutic, psycho-social, DME, and psychiatric needs.
- Conducted early discharge planning, identified barriers of care, and coordinated services for veterans with diverse needs, including medical/surgical and behavioral health.
- Advocated for veterans' needs throughout admission and discharge.
- Advocated for patients' needs within healthcare system, ensuring access to appropriate resources and services.
- Participated in interdisciplinary team meetings to discuss complex cases and develop coordinated care strategies.
- Referred patients to appropriate specialists or support services based on their unique circumstances.
- Supported continuum of care by assessing, planning, implementing and evaluating patient progress.
- Developed case management plans and established goals.
- Actively participated in RN PBI interview panels.
Assistant Nurse Manager PM&R
San Juan VA Medical Center
07.2017 - 07.2019
- Supervised, directed, and motivated high-quality performance from nursing staff.
- Developed departmental goals and objectives to improve satisfactory rating with patients.
- Performed real-time chart audits for patients ensuring accuracy and completeness of information while capitalizing on opportunities for process improvement.
- Verified facility remained up-to-date and compliant with protocols and regulations.
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Promoted professional development opportunities to encourage nurses to pursue continuous training.
- Investigated and independently resolved complaints from staff, physicians, and patients by leveraging clinical judgment and unit management expertise.
- Fostered improvement in staff development, personnel training, and standards of patient care.
- Oversaw infection control procedures to protect patients from infections and keep nursing departments compliant with state regulations.
- Evaluated skills of nursing personnel and verified staff certifications for validity.
- Communicated with patients, ensuring that medical information was kept private.
- Liaised with other healthcare professionals to develop comprehensive patient care plans and provide highest quality of care.
- Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
- Conducted routine facility inspections, identifying areas needing improvement and eliminating hazards posed to staff and residents for continued compliance with associated regulations.
- Monitored and inspected staff processes to eliminate hazards posed for both patients and staff while ensuring continuous compliance with regulations.
- Investigated complaints from patients or family members and took appropriate action to resolve conflicts or issues in a timely manner.
- Assisted with examinations, treatments and office procedures.
- Maximized unit efficiency, keeping supplies, and records well-organized for expected needs.
- Conducted regular rounds on patients to assess their condition, respond to medical concerns, and ensure appropriate interventions were in place.
- Incorporated information from evaluations and applied clinical expertise and judgment to adjust nursing interventions.
- Monitored patient conditions and responses to identify and report concerns.
- Entered daily data into VA -NHPPD staffing database.
- Educated and prepared staff for Joint Commission & CARF visits by ensuring clarity of procedures and protocols are well understood.
Registered Nurse PM&R
San Juan VA Medical Center
08.2012 - 07.2015
- Interpreted and evaluated diagnostic tests to identify and assess patients
- Documented patient medical histories and symptoms.
- Coordinated paperwork to facilitate smooth patient discharges.
- Administered intravenous and oral medications to patients.
- Delegated tasks effectively within nursing team based on individual competencies.
- Maintained clean, safe environment for patients by adhering to infection control policies.
- Administered medications as prescribed by physicians.
- Utilized evidence-based practices in daily nursing activities to optimize clinical outcomes.
- Performed wound care and dressing changes for patients with injuries or surgical sites.
- Provided non-intravenous medications and monitored side effects.
- Implemented care plans according to patient needs and priorities.
- Modified patient treatment plans based on patient responses and conditions.
- Examined health care reports and records to determine accuracy of patient information.
- Supervised and mentored less-skilled nursing or healthcare personnel and provided leadership on a particular unit.
- Consulted and coordinated with healthcare team members to assess, plan, implement, or evaluate patient care plans.
- Monitored all aspects of patient care, including diet and physical activity.
- Prepared rooms, sterile instruments, equipment, or supplies, ensuring stock maintenance.
- Administered medications as stipulated in medical orders: IVP, Intravenously, Subcutaneous, Intramuscular.
- Proficient in the use of CPRS and BCMA for medication administration.
- Consistently served as a preceptor for new employees, student nurses, and employee floaters.
- Assisted in unit quality rounds and mock surveys.
- Conducted a special assignment, researching data for the new FTEE position in the rehabilitation unit nurse educator role.
- Educated patients about their disease condition and reinforced instructions regarding positioning, transfers, and the use of adaptive devices.
- Provided direct patient care for veterans with a broad scope of medical conditions, including chronic behavioral health conditions.
- Participated in quality improvement initiatives to enhance patient care outcomes.
- Managed Unit Quality Monitors: Catheter-Associated Urinary Tract Infection (2013-2015): Conducted continuous and extensive staff education, resulting in a decrease from 2.3% to 0%.
- Selected as chairperson (2015-2016) -Unit Base Council. -Increased employee morale through external team-building events and implemented a dream board to celebrate accomplishments and future goals.
Registered Nurse Stroke Coordinator
HIMA San Pablo Hospital
12.2010 - 08.2012
- Provide consultation to nursing, pharmacy, medical staff, and others to develop, implement, and evaluate a comprehensive
plan of care, including a discharge plan, for patients with stroke to achieve desired patient outcomes. - Verbally communicate pertinent information with key clinicians in a timely manner. Utilizing appropriate documentation tools
for effective written communication. - Collaborated with the Medical Director of the Stroke Program, guiding stroke committees, teams, and workgroups.
- Participated in weekly new employee conferences and provided in-services to nursing staff on competency and compliance with American Stroke Association standards.
- Educated the Emergency Department and Intensive Care Unit on best practice stroke care, including tPA delivery, post-tPA monitoring, and management of complications.
- Developed and coordinated community stroke awareness events.
- Revised the stroke education program to ensure compliance with Joint Commission standards.
- Organized the annual stroke education for physicians alongside the medical director.
- Served as a Stroke Care Navigator, ensuring proper care throughout the patient's admission.
- Participated in unit nurse manager rounds to ensure Joint Commission compliance and aided when deficiencies were identified.
- Established and maintained data on tPA administrations, door-to-needle time frames, and tracked the defined patient population.
- Updated electronic data into the “Get with the Guidelines” database.
- Participated in the quarterly AHA Stroke Coordinators Conference in Puerto Rico.
- Updated medical providers on restructured stroke core measures for compliance based on TJC standards.
- Conducted quality team rounds, performing ongoing tracer activities for various units, including Surgery, ER, ICU, and the Stroke unit.
- Worked alongside Intensive Care, Stroke, and Emergency Room Physicians and Supervisors to provide standardized care and education to patients and family members.
- Assessed patient health by interviewing patients, reviewing medical history, and performing physical examinations.
- Educated patients on preventive care and lifestyle choices to improve overall health.
- Educated patients and caregivers on proper at-home care and treatment regimens.
- Served as resource person for other healthcare professionals seeking advice guidance clarification regarding complex clinical issues ethical dilemmas policy interpretations.
- Facilitated patient-family conferences by mediating conflicts, clarifying misunderstandings and providing information about available resources options for care.
- Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
- Reported findings to quality departments after conducting routine restraint audits and worked with team to devise corrective actions for deficiencies.
- Led teams in driving successful patient outcomes by prioritizing standard of care and best practices.
- Equipped patients with tools and knowledge needed for speedy and sustained recovery.
Medical Office Specialist
Arthritis & Osteoporosis Center
01.2004 - 07.2005
- Received, recorded and filed medical payments by check, cash, and credit card.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Gathered forms and copied insurance cards to collect patient information for billing and insurance filing.
- Contacted patients regarding unpaid and underpaid accounts to resolve issues.
- Coordinated patient scheduling, check-in, check-out and payments for billing.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Adhered to strict HIPAA guidelines to protect patient privacy.
- Prepared patient charts by gathering and organizing medical records ahead of appointments.
- Provided prompt, polite and professional in-person and telephone customer service.
- Reconciled daily payments received and prepared deposits for smooth office finances.
- Registered patients and completed associated paperwork for accurate records.
- Updated patient information and insurance details for accurate electronic medical records.
- Conducted patient intake interviews, recording and documenting relevant information.
- Performed various administrative tasks by filing, copying and faxing documents.
- Completed administrative patient intakes with case histories, insurance information and mandated forms.
- Scheduled patient appointments in respective doctors' calendars and followed up with reminder phone calls.
- Managed office logistics by scheduling appointments, maintaining files and collecting payments.
- Organized and maintained patient chart filing system to promote quick data finding for staff.
Summary
Seasoned nursing professional offering proven clinical knowledge, natural interpersonal strengths and technical abilities. Knowledgeable about EMR charting, medication administration and interdisciplinary collaboration focused on optimizing patient care and support. Quality-focused and efficiency-driven leader.
Education
Master of Science - Family Nurse Practitioner
Ana G Mendez (CCNE)
Gurabo, PR 08.2022 - 06.2024
Bachelor of Science - Nursing
Columbia Central University
Caguas, PR 08.2009 - 12.2010
Associate of Science - Nursing
Columbia Central University
Caguas, PR 02.2006 - 08.2009
Skills
- Quality improvement
- Clinical assessment
- Adaptability and flexibility
- Team collaboration
Languages
English
Full Professional
Spanish
Full Professional
Timeline
RN Case Manager
HCA Largo Medical Center
12.2024 - Current
Master of Science - Family Nurse Practitioner
Ana G Mendez (CCNE)
08.2022 - 06.2024
Case Manager Supervisor
Humana
10.2020 - 08.2022
RN Case Manager
Humana
02.2019 - 10.2020
RN Case Manager
Audie L Murphy VA Hospital
07.2017 - 02.2019
Assistant Nurse Manager PM&R
San Juan VA Medical Center
07.2017 - 07.2019
Registered Nurse PM&R
San Juan VA Medical Center
08.2012 - 07.2015
Registered Nurse Stroke Coordinator
HIMA San Pablo Hospital
12.2010 - 08.2012
Bachelor of Science - Nursing
Columbia Central University
08.2009 - 12.2010
Associate of Science - Nursing
Columbia Central University
02.2006 - 08.2009
Medical Office Specialist
Arthritis & Osteoporosis Center
01.2004 - 07.2005
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