Summary
Overview
Work History
Education
Skills
Certification
Languages
Timeline
Generic

PATRICIA GUZMÁN

Miami

Summary

Multistate licensed registered nurse with a strong background in nurse auditing within claims administration and Payment Integrity. Exceptional communication, interpersonal, and organizational skills in both Spanish and English. Extensive hands-on clinical experience in Home Health and Acute hospital settings, highlighting adeptness in navigating challenges. Proactive problem-solving abilities facilitate efficient completion of new tasks. Recognized for adaptability, creativity, and a results-oriented mindset, dedicated to making impactful contributions and advancing organizational goals.

Overview

14
14
years of professional experience
1
1
Certification

Work History

Nurse Auditor

Humana
11.2021 - Current

Audit Home Health and SNF claims.

Review utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent and detect fraud, waste, and abuse.

Performs clinical audit/validation processes to ensure that medical record documentation and diagnosis coding for services rendered is complete, compliant and accurate to support optimal reimbursement.

Case Manager / Clinical-System Trainer

One at Home Dade
01.2017 - 11.2021
  • Liaise with medical insurance and doctors to ensure best possible care at home
  • Conduct training sessions for home health aides and nurses to teach required skills and knowledge
  • Leverage cost-efficient resources to devise and executed quality patient care plans in accordance with requirements

Director of Nursing

On the Way Home Care
01.2016 - 01.2017
  • Developed and applied new and improved policies to enhance patient care standards
  • Envisioned and created short and long-term objectives and goals for nursing department
  • Oversaw cross-functional staff of case managers, lead nurses, and home health aides to maintain efficient workflow

Case Manager

On the Way Home Care
01.2014 - 01.2016
  • Collaborated with medical directors and health care professionals to conduct case reviews
  • Provided long-term patient care and rehabilitation facilities to aid patient in living healthy life
  • Coordinated and provided safe, cost-effective, efficient, and client-centered patient care

Registered Nurse/ Relief Charge Nurse

Kendall Regional Medical Center
01.2011 - 01.2014
  • Delivered post-operative teaching and expectations before discharge, medication administration, wound care, diet considerations, follow-up appointments, and emergency notification
  • Collaborated with the health care team to ensure standards of care during operative and immediate post-operative phase

Education

Bachelor of Science - Nursing

University of Phoenix
01.2018

Associate of Science - Nursing

Keiser University
01.2011

Skills

  • Health Care Management
  • OASIS expert
  • Patient Assessment
  • Case Management
  • Medical billing codes
  • Team building
  • Information Management
  • Confidentiality

Certification

  • Basic Life Support
  • Licensed Multistate Registered Nurse

Languages

Spanish
Native or Bilingual

Timeline

Nurse Auditor

Humana
11.2021 - Current

Case Manager / Clinical-System Trainer

One at Home Dade
01.2017 - 11.2021

Director of Nursing

On the Way Home Care
01.2016 - 01.2017

Case Manager

On the Way Home Care
01.2014 - 01.2016

Registered Nurse/ Relief Charge Nurse

Kendall Regional Medical Center
01.2011 - 01.2014

Associate of Science - Nursing

Keiser University

Bachelor of Science - Nursing

University of Phoenix
PATRICIA GUZMÁN