Cindia Janet Reyes
Riverview,Florida
Summary
Diligent Caregiver focused on providing optimal support to clients through personalized assistance and care required to manage diverse medical conditions. Proficient in organizing medications, doctor appointments and personal activities. Caring, organized and friendly with excellent interpersonal skills.
Overview
27
27
years of professional experience
Work History
Care manager-Bilingual
OptumCare
08.2015 - Current
- Reports to the Manager of Care Management and is responsible for the oversight of pre-certification, patient care management, discharge planning, and health plan compliance within the center
- Monitor inpatient, outpatient, and SNF patients and initiate patient care arrangements
- Reports findings to Medical Management, Medical Director and Center Administrator
- Provide oversight in patient care evaluation, coordinate the collaboration of the Primary Care Provider and consultants, and make suggestions to improve plans meet patient needs
- Assist with the monitoring of utilization management and make recommendations regarding effectiveness of health care resources, trending and intervention
- Assist in the assessment of clinic operations and make recommendations as necessary
- Consistently apply guidelines to the medical record review process
- Evaluate and recommend health delivery network changes with the Medical Director and Center Administrator
- Participate in QI projects
- Attend Care Management Meetings
- Participate in patient satisfaction program as required and follow up on all inpatient/outpatient discharges
- Assist the Center Medical Director with the management of high-risk patient populations and appropriate care management plans.
- Assisted clients with daily living needs to maintain self-esteem and general wellness.
- Educated clients and families on community resources, treatment options and health care services to better manage conditions.
UR Managed Care Nurse
Integrated Health Solution
05.2015 - 07.2015
- Provide admission and concurrent review on inpatient members
- Ensure and facilitate quality and cost effective health care delivery
- Review all inpatient admissions and initiates discharge planning in a timely manner
- Utilize clinical skills, chart review, physician communication and Milliman for Criteria
- Conduct ongoing review for members in inpatient stay and utilize peer review, as necessary
- Complete onsite and/or telephonic admission and concurrent reviews for medical necessity
- Communicate requests which do not meet criteria with UR Coordinator and Health Choice
- Medical Director(s) for determination
- Provide notification to facility of determination
- Facilitate member's transfers within contracted facilities for ongoing inpatient stays
- Initiate interdepartmental coordination to ensure quality and timely care for members
- Complete prior authorizations as needed for discharge planning
- Monitor utilization of non-medically necessary services and redirect as needed.
Case Management/Disease Management
Integrated Health Solution
05.2014 - 05.2015
- Act as a liaison to facilities, providers and/or members related to issues in case management and care services
- Identify member needs and address these needs to remove any barriers in achieving optimal behavioral health and medical care
- Educated members on the importance of good health and following up to the Primary Care Physician or specialist on a regular basis
- Request and review medical records
- Provide member education on disease processes
- Develop and monitor the member's care plan goals for progress and outcomes
- Specialty Pharmacy: Identify members through the daily inpatient census, who are readmit within the last thirty (30) days and/or have specific disease conditions, such as, HIV,HCV, RA CHF, COPD, DM
- Coordinate with all providers involved in the treatment of members identified as needing assistance with managing chronic medical conditions
- Notify the member's Primary Care Physician and Specialist of admission and discharge from any inpatient setting to facilitate coordination of care
- Monitor progress towards treatment goals.
Clinical Coordinator (Research & Infusion)
Specialty Pharmacy Nursing Network (SPNN)
06.2013 - 05.2014
- Responsible for communicating with patients, clinicians and MD office staff to provide confirmation of SPNN services coordinated
- Follow up of services provided to MD and SPNN customers
- Review and approve all nursing documentation
- Contact the patient to validate the start of care date, answer any questions the patient or caregiver may have relative to the therapy and ongoing treatment
- Coordinate with the pharmacy regarding delivery of drug and supplies for the start of care
- Coordinate with the nurse/agency regarding date and time of scheduled visits
- Communicate with the physician's office regarding patient status and any questions or concerns prior to the start as well as on going
- Ensure that all nursing documentation forms are provided to nurse/agency
- Follow up on visits made with patients and assess patient satisfaction with service
- Review and approve all nursing documentation
- Maintain performance indicator of: Nursing Documentation received within 48 hours, from nurse/agency visit
- Nursing documentation faxed to MDO and customers within 5 days of visit
- Clinical Research Coordinator: Clinical Trials Acute Kidney Injury (AKI), HCV, Psoriasis
- Inform patients or caregivers about study aspects to be expected and procedures
- Schedule subjects for appointments with home nurse trial support
- Monitor study activities to ensure compliance with protocols and with all relevant local, federal, and state regulatory and institutional policies
- Communicate with laboratories or investigators regarding laboratory findings
- Arrange courier service for specimen pick up, equipment and supplies for home nurse clinical support and determine staff or equipment availability
- Communicate with Clinical Coordinator and Principal Investigators regarding adverse event and site effect
- Instruct nurses for home trial support in scientific and procedural aspects of studies including standards of care, informed consent procedures, or documentation procedures, Good Clinical Practice(GCP),Homecare Nurse Training Presentation, IATA Training Module, SMART Training Module.
SNP Care Coordinator
Healthintegrated
11.2012 - 03.2013
- Performs telephonic data collection, health education and care coordination activities, communicating with the multidisciplinary team in the timeframes required to meet program goals and objectives
- Collects pertinent clinical data (including specific claims data when available), documenting findings using the HI case management information system program/hard copy charting
- Promotes alternative care and funding programs and researches available options to maximize health benefits and/or replace limited or excluded benefits
- Consults with the designated Medical Director regarding member cases with question about appropriateness of care, evidence based care guidelines, medication questions, practitioner care plans, etc
- Refers cases to HI legal and/or health purchaser's legal staff where there is a threat of litigation and/or those patient's specified by the legal department for immediate referral
- Maintains an active role in assuring continuity of care for patients through early identification and appropriate discharge planning by close and frequent collaboration with the hospital discharge planning/social worker staff.
Lead Triage Reviewer
CareCentrix
04.2012 - 08.2012
- Receives/responds to incoming calls from referral sources/potential clients, exchanges information to identify the client's needs and determines CareCentrix' ability to meet them
- Holds all referrals until all information is verified as complete and the next steps are determined
- Handles verification of all referrals funneled through Triage, verifying information, applying business rules and determining the next steps
- Acts as a clinical resource to department care coordinators, providing expertise and clinical knowledge.
Clinical Coordinator Management
Walgreens Infusion Services
05.2008 - 04.2012
- Responsible for the overall management, direction, and compliance of the clinical services provided in accordance with the policies and procedures
- Responsible for complete patient assessment for assigned patients, establishing and implementing patient care plans, educating patients/caregivers, evaluating progress towards patient goal
- Ability to communicate effectively with team members, patients, caregivers, physicians and referral sources
- In charge of staffing, nurse scheduling, chart audit, triage new referrals, on call
- Ability to teach and train staff, patients, caregiver's clinical services such as: IV pump, Enteral Pump, Cardiac Program.
Manager Hispanic Marketing
Cryo-Cell International
03.2005 - 03.2008
- Develop and execute strategies to increase the awareness of cord blood banking and Cryo-Cell within the Hispanic Community
- Key materials are developed in Spanish including websites, enrollment forms, consumer collateral materials, newsletters and advertising
- Organize booth materials and travel to expectant patents fairs in Florida, Puerto Rico, California, Chicago and New York
- Experienced in sales at trade shows as well as through telephone and on-line channels
- Give interviews and offer educational experiences/stories on television, radio and in print
- Marketing and sales efforts resulted in exceeding established baselines in Florida and Puerto Rico by 50% and 300% respectively
- Puerto Rico market rose from 11th in overall U.S
- Revenues to 3rd, despite lower average household income
- These markets currently provide more than 25% of U.S
- Revenues for new enrollments.
Clinical Coordinator
Cryo-Cell International
02.2004 - 03.2008
- Educate expectants parents and family about cord blood banking; enroll parents in Cryo-Cell services; coordinate and schedule shipment of specimen collection kit and associate paperwork
- Educate physicians, labor and delivery nurses and other caregivers on the procedure for specimen collection and transportation
- Educate parents, physicians, labor and delivery nurses and other caregivers about benefits of cord blood stem cells
- Serve as liaison between laboratory director, parents and caregivers regarding potential for use of specimen for a transplant procedure.
Rehab LPN
HealthSouth Rehab Hospital
02.2002 - 02.2004
- Patient Care, Medication administration, Review Physicians orders, Chart, Wound care, patient/family teaching.
Rehab LPN
VA Medical Center
12.1999 - 01.2002
- Patient Care, Computerized patient record system, bar code medication administration, wound care, committee for patient/family teaching and quality of life.
Rehab LPN
Ryder Memorial Hospital
07.1997 - 11.1999
- Patient Care, Medication administration, Review Physicians orders, Chart, Wound care, patient/family teaching.
Education
Photography -
Columbia Centro College
06.1999
Licensed Practical Nurse -
Ryder Memorial Hospital
07.1997
Micro-Computer Operator -
Data Institute and Business College
07.1992
Skills
- Micro-Computer Operator
- IV Certified
- Computerized Charting
- Bilingual in English and Spanish
- Professional Photographer
- Medical Research Network (MRN)
- Good Clinical Practice
- Homecare Nurse Training Presentation
- IATA Training Module
- SMART Training Module
Timeline
Care manager-Bilingual
OptumCare
08.2015 - Current
UR Managed Care Nurse
Integrated Health Solution
05.2015 - 07.2015
Case Management/Disease Management
Integrated Health Solution
05.2014 - 05.2015
Clinical Coordinator (Research & Infusion)
Specialty Pharmacy Nursing Network (SPNN)
06.2013 - 05.2014
SNP Care Coordinator
Healthintegrated
11.2012 - 03.2013
Lead Triage Reviewer
CareCentrix
04.2012 - 08.2012
Clinical Coordinator Management
Walgreens Infusion Services
05.2008 - 04.2012
Manager Hispanic Marketing
Cryo-Cell International
03.2005 - 03.2008
Clinical Coordinator
Cryo-Cell International
02.2004 - 03.2008
Rehab LPN
HealthSouth Rehab Hospital
02.2002 - 02.2004
Rehab LPN
VA Medical Center
12.1999 - 01.2002
Rehab LPN
Ryder Memorial Hospital
07.1997 - 11.1999
Photography -
Columbia Centro College
Licensed Practical Nurse -
Ryder Memorial Hospital
Micro-Computer Operator -
Data Institute and Business College
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