Carlos Guerra
Miami,FL
Overview
17
17
years of professional experience
1
1
Certification
Work History
CASE MANAGER- CARE COACH
CONVIVA CARE SOLUTIONS
10.2016 - Current
- The Care Coach’s priority daily is outreach calls, and in-office visits with members discharged home from hospital/SNF/Rehab within the past 30 days
- Identify and Close gaps related to discharge needs: Home Health, DME, Transportation, Meals, Disease mgt/Medication education, COPD/CHF zone action plan
- Schedule follow-up visit with PCP within 3-5 business days of hospital discharge
- Weekly follow-up calls or in-office visits with members during the first 4-6 weeks of the hospital discharge
- Daily Clinical Huddles with PCP Review members discharged from hospital: reason for admission, follow-up needs, follow-up appt date
- Members Readmitted to hospital – any missed opportunities
- Members from ACSC COPD & CHF registries scheduled to be seen that day: follow-up needs, education, medications, Flu/Pneumonia vaccines, participation in weight-monitoring program
- ACSC Registries: The Care Coach will review the ACSC Registries every week
- Immediate Priority: Begin outreach calls to COPD members listed on the PAM report and ACSC registries that have had ER Visits/Admissions
- COPD disease management education, Zone action plan, “emergency medication kit”, and schedule for Flu & Pneumonia vaccines as needed
- Next: Outreach calls to Heart Failure members listed on PAM report and ACSC registries that have had ER Visits/Admissions
- Heart Failure disease management education, Zone action plan, enrollment in weight-monitoring program as appropriate, schedule for Flu & Pneumonia vaccines as needed
- Provider Accountability Model (PAM) report The Care Coach will review the PAM report each month
- Discuss with PCP potential opportunities and develop Care Plan for members with stratification level “high severity” and “health/functional challenged” listed on PAM who have had an ACSC diagnosis admission during the current calendar year
- Monthly Deep Dive meetings The Care Coach will participate in Monthly Deep Dive meetings, review status of members from PAM, Registries, Readmissions, work with PCPs to identify other opportunities to reduce Readmissions, avoidable ER visits and avoidable hospital admissions.
LEAD MANAGED CARE TECH II
COMMUNITY HEALTH OF SOUTH FLORIDA, INC.
04.2014 - 10.2016
- Process authorization requests for emergency treatment, specialty, and ancillary services for managed care enrollees
- Ensure referral request forms are accurately completed and processed promptly
- Enter authorization in the computer system for all clients enrolled in HMO
- Complete a minimum of 20 referrals per day
- Respond to telephone inquiries regarding coverage and benefits, appointments, referrals, etc., from clients, insurance companies, personnel and providers
- Schedule appointments with health care providers
- Participate in Performance Improvement Activities
- Participate in appropriate continuing education in-service training
- Maintain current licensure and/or certificates
- Performs other duties as assigned.
ADMINISTRATOR/ LPN
ARMS OF LOVE HOME HEALTH AGENCY, INC.
07.2012 - 05.2013
- Performed administrative functions for Home Health Agency
- Produced the patient Plans of Care based on the Registered Nurse Assessments
- Responsible for staffing nurses, therapists, and Home Health Aides for patients admitted to home health care
- Responsible for payroll and billing
- Responsible for up-to-date transmission of patient assessments to Medicare
- Monitoring of active census and discharged patients
- In charge of tracking inventory of office supplies
- Assisting diabetic, hypertensive, wounded, IV, and vitamin deficient patients in their home.
ADMINISTRATIVE ASSISTANT/HUMAN RESOURCES
S&S HEALTH CARE MANAGEMENT, INC
03.2009 - 06.2012
- Performed administrative support functions for the Administrators, Assistant Administrators and Director of Nursing of Home Health Agencies
- Produced the patient Plans of Care based on the Registered Nurse Assessments
- Responsible for staffing nurses, therapists, and Home Health Aides for patients admitted to home health care
- Posted all visit notes from nurses, therapists, and home health aides for payroll and billing purposes
- Responsible for up-to-date transmission of patient assessments to Medicare
- Monitoring of active census and discharged patients’ weekly and released nurses’ weekly schedule
- Provided telephone support and reception services; managed the filing system of patients’ charts
- In charge of tracking inventory of office supplies.
ASSISTANT MANAGER
ADVANCE AUTO PARTS
10.2006 - 03.2009
- Completing, filing, and submitting paperwork to keep up with company’s headquarters
- Handling customer transactions or writing up reports for future repairs or orders
- Responsible for the scheduling, interviewing, hiring, and training of employees
- Providing service to customers and assisting entry level associates or technicians during busy periods.
Nurse II
Community Health Of South Florida
- Nurse II is responsible for providing nursing assessments, dispensing medication, formulating treatment plans, and overseeing the psychiatric management of the patient in coordination with the Attending Physician
- He or she functions under the guidance of their state licensure, within the CMHC in accordance with standards of State and Federal regulations.
Education
Associate Degree in Nursing -
Fortis College-Cutler Bay, FL
09.2019
Licensed Practical Nursing Program -
MedVance Institute- Miami, FL
07.2011
Miami Dade College- Miami, FL
01.2008
Miami Coral Park Senior High School
01.2004
Skills
- Computer
- Microsoft Word
- Excel
- PowerPoint
- Wordpad
- Igea
- Alora
- Intergy
- Chameleon
- ECW (EHR) medical P
- Communication
- Deals with internal personnel and external customers at all levels via telephone and email, to ensure success
- Planning and organizing
- Refined planning and organizational skills that balance work, team support and responsibilities in a timely and professional manner
- Time Management
- Accomplishing specific tasks, projects, and goals, complying with all due dates This set encompasses a wi
- Customer Service
- An unwavering commitment to customer service, with the ability to build productive relationships, resolve
- Leadership
- Being able to constructively offer suggestions to team members, encourage, and stay on top o
Certification
- Registered Nurse License RN9534363
- Current CPR, AED (BLS)
- Medical Error & Omissions HIV/AIDS, Domestic Violence HIPPA, OSHA, IV Certification.
Clinical Experiences
- Nursing Home at Mercy Hospital, Geriatric, Basic nursing skills, medication administration, tube feeding, vital signs monitoring, prioritizing of patients, delegating care, and legal aspects of documentation.
- Kindred Hospital, Medical/Surgical, Medication administration, Basic Nursing Skills, dressing changes, vital signs monitoring, feeding, chart documentation.
- Palmetto General Hospital, Medical/Surgical, basic nursing skills, medication administration, NG tube feeding, vital signs monitoring.
- Hialeah Hospital, Obstetrical, Fetal monitoring, contraction monitoring, patient comfort while in labor, helping with epidural administration, Foley catheter placement, helping in vaginal and cesarean births, monitoring mother and babies. Feeding neonates, and administering medication.
- Hialeah Hospital, Pediatric, Basic nursing skills, medication administration, charting, vital signs monitoring.
References
Upon request
Languages
English
Limited
Spanish
Professional
Timeline
CASE MANAGER- CARE COACH
CONVIVA CARE SOLUTIONS
10.2016 - Current
LEAD MANAGED CARE TECH II
COMMUNITY HEALTH OF SOUTH FLORIDA, INC.
04.2014 - 10.2016
ADMINISTRATOR/ LPN
ARMS OF LOVE HOME HEALTH AGENCY, INC.
07.2012 - 05.2013
ADMINISTRATIVE ASSISTANT/HUMAN RESOURCES
S&S HEALTH CARE MANAGEMENT, INC
03.2009 - 06.2012
ASSISTANT MANAGER
ADVANCE AUTO PARTS
10.2006 - 03.2009
Nurse II
Community Health Of South Florida
Associate Degree in Nursing -
Fortis College-Cutler Bay, FL
Licensed Practical Nursing Program -
MedVance Institute- Miami, FL
Miami Dade College- Miami, FL
Miami Coral Park Senior High School
- Registered Nurse License RN9534363
- Current CPR, AED (BLS)
- Medical Error & Omissions HIV/AIDS, Domestic Violence HIPPA, OSHA, IV Certification.
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