Christine Rubio

• Member of the Multidisciplinary Level 2 Trauma team. Provide clinical counseling, crisis intervention, and respond and assess all trauma calls.
• Provide Case Management focusing on discharge planning, attend family meetings, collaborate with skilled nursing facilities, LTACs, and home health agencies for transition of care from the ED.
• Work professionally and effectively with attending physicians, charge nurses, bedside nurses and all other disciplines involved with the patient's care.
• Working knowledge of various units within the hospital such as MICU, SICU,OBS and Neuro. Attend unit rounds with interdisciplinary medical team.
• Collaborate with interdepartmental providers such as Hospice/Palliative care, Spiritual Care, and Substance abuse counselors.
• Knowledge of community resources throughout the San Diego County to provide and refer patients to appropriate resources for continuity of care. Promote awareness and empowerment to each individual.
• Knowledge of insurance plans and facilitate obtaining authorizations for services a patient may require to ensure a safe and cost-effective discharge.

• Participate in a collaborative process with the interdisciplinary team to assess, plan, implement, coordinate, monitor and evaluate options and services to meet individual's health care needs while promoting quality, cost-effective outcomes.
• Participate in the utilization review process for patients and ensure proper and safe discharge from all units of the hospital.
• Collaborate and make referrals to appropriate healthcare providers and community resources for continuity of care and to ease the patient's transition through the continuum of care.
• Demonstrates knowledge of local, state and federal regulations and guidelines in acceptance with policies, procedures, mission and objectives as well as with those of Tenet.
• Provide compassionate care to a diverse patient population while ensuring a comprehensive discharge plan. Working knowledge in various units of hospital -ER, ICU, Ortho/Neuro, Telemetry and the Wound unit.
• Collaborate with the Psychiatric Assessment Team for all units in addressing dual diagnosis patient's needs for discharge.

• Collaborate with non-profit agencies, external vendors to increase Medicaid enrollment by assisting in open enrollment fairs, organization of health fairs, oral presentations to audiences who benefited from Hoosier Healthwise and the Healthy Indiana Plan.
• Assisted with HEDIS-quality review team to ensure contractual providers met the criteria of the State in providing quality health services to the Medicaid patients Reviewed patients records and provided medical providers with additional education as needed.
• Represent Anthem as a business partner by attending State networking events, committees, member of advisory boards and a resource for the State of Indiana.
• Home visits made to educate and ensure proper usage of ER visits and attending scheduled doctor visits. Implemented "Take a Love One to the Doctor Day" once a year. Coordinated with Dr. offices to schedule appointments for our patients.

Utilization Management Representative

• Responsible for coordinating cases for precertification and prior authorization review for National Local accounts.
• Essential duties included: Assists callers with questions concerning eligibility and/or benefit information. Gather information so the RN can perform precert or concurrent review.
• Provide customer service to providers, policy holders regarding insurance products, benefit issues and problem solve to ensure each call is handled efficiently and professionally.
• Collaborated with other departments to address issues that required further insight or review such as Appel Dept., Pre-Determination and Case Management.