Claudia F Varela

• Improved patient outcomes by developing comprehensive care plans tailored to individual needs.
• Collaborated with interdisciplinary teams for optimal patient care and resource utilization.
• Ensured timely and accurate documentation of patient data, maintaining compliance with regulatory requirements.
• Reduced hospital readmission rates by providing thorough discharge planning and follow-up care coordination.
• Facilitated smooth transitions between levels of care by coordinating necessary services, medical equipment, and provider referrals.
• Provided ongoing support to families during acute episodes, offering guidance on complex decision-making processes.

*Coordinates and schedules the daily work load of each district utilizing agency personnel to their duty capacity.

*Provides daily contact supervision of field nurses, other healthcare professionals, and home health aides to assure the quality of services and maintenance of standards.

*Review and investigates the clinical content, diagnosis, medical history, medications, fee status and other procedures of the record of patients under their supervision.

* Participate in audits, interdisciplinary team conferences and represents agency in the community as requested.

Collaborate with nursing, physicians, admissions, fiscal, legal, compliance, coding, and billing staff to answer clinical questions related to medical necessity and patient status.

Collaborate with all members of the healthcare team, both internal and external customers.

Identify inappropriate utilization of services/settings through the application of establish clinical criteria using InterQual and CMS guidelines for medical necessity.

Review the clinical needs of potential patients to ensure consistency with InterQual criteria and hospital services.

• Collaborated with interdisciplinary teams to ensure seamless transitions from hospital to home or other care facilities.
• Enhanced patient outcomes through thorough follow-up assessments and adjustments of discharge plans as needed.
• Streamlined the discharge process, reducing wait times and increasing overall efficiency within the hospital.
• Review patient cases and ensure that the patient is receiving the proper treatment.

Plan, coordinate, monitor and evaluate options and services required to meet the patient's health need.

Work closely with physicians and other health team members to provide care to high-risk, medically complex patients across the continuum.

Ensure that patients are receiving the services they need to achieve an optimum quality of life, the care manager coordinates treatments and providers, facilitates safe transitions between hospital and outpatient settings and educates patients, families and providers on best health practices and services in the outpatient setting.

• Enhanced patient care by developing comprehensive care plans and coordinating with interdisciplinary healthcare teams.
• Collaborated closely with physicians to develop individualized treatment plans, supporting optimal patient outcomes.
• Served as a key liaison between patients, families, and healthcare providers, fostering open communication and trust among all parties involved in the care process.

A dedicated Case Manager/Discharge Planner formulating a comprehensive assessment for the
acute care patient's discharge needs. Duties include, but not limited to assessing patient’s
physical and mental wellness, helping patients achieve autonomy and providing a safe and
timely discharge plan from the hospital.

Collaborated with interdisciplinary teams for comprehensive patient care plans, resulting in better health outcomes.

• Enhanced patient care by implementing evidence-based nursing practices and developing individualized care plans.
• Streamlined nursing processes for increased efficiency, resulting in improved patient satisfaction scores.
• Collaborated with interdisciplinary team members to optimize patient outcomes through comprehensive care coordination.
• Mentored and supervised junior nurses, fostering a supportive and collaborative work environment.

• Improved patient care quality by conducting thorough utilization reviews and making recommendations for optimal treatment plans.
• Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
• Enhanced patient satisfaction by collaborating with interdisciplinary teams to develop individualized care plans, ensuring appropriate level of care.
• Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.