DELSY RODRIGUEZ
Ocoee,FL
Summary
Analytical, organized and detail-oriented RN, BSN with expertise and experience in the full spectrum of Nursing. Collaborative team player with ownership mentality and a track record of delivering the highest quality to the patient/client under my care. Hardworking Registered Nurse with success providing individualized patient care. Committed to delivering best-in-class patient care through effective education and counseling. Proven leadership focused on increasing and enhancing patient care and satisfaction. Streamline safety protocols for comprehensive patient care.
Overview
11
11
years of professional experience
1
1
Certification
Work History
RN Care Manager - Remote
Better Health Group
04.2022 - 03.2024
- Working as a Care Manager for Better Health Group
- Duties as follows: Assess the member’s current health status, resource utilization, past and present treatment plan and services, prognosis, short- and long-term goals, treatment, and provider options
- Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member’s needs and promote desired outcomes
- Coordinate services between Primary Care Physician, specialists, medical providers, and non- medical staff as necessary to meet the complete medical socio-economic needs of clients
- Monitor referrals made to community-based organizations, medical care and other services to support the member’s overall care management plan
- Facilitate member access to community-based services
- Actively participate in integrated team care management rounds
- Identify related risk management quality concerns and report these scenarios to the appropriate resources
- Engaging with high risk members (primarily telephonically) to understand their needs, supported by technology and data tools
- Conducting holistic assessments to identify comorbid conditions, ED/hospitalization history, medications, psychosocial factors, and patient values and preferences
- Developing care plans in partnership with patient/member and their caregivers - problems, goals, interventions - while continuously evaluating the patient/member’s progress
- Explaining complicated medical terms in plain language
- Educating members on their chronic conditions including teaching “red flags,” developing plans during an exacerbation, and identifying barriers to important care elements such as medication adherence.
RN Care Manager II
Sunshine Health Plan
06.2017 - 03.2022
- Working as a Care Manager for Sunshine Health Plan
- Duties as follows: Assess the member’s current health status, resource utilization, past and present treatment plan and services, prognosis, short- and long-term goals, treatment, and provider options
- Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member’s needs and promote desired outcomes
- Coordinate services between Primary Care Physician, specialists, medical providers, and non- medical staff as necessary to meet the complete medical socio-economic needs of clients
- Monitor referrals made to community-based organizations, medical care and other services to support the member’s overall care management plan
- Provide patient and provider education
- Facilitate member access to community-based services
- Actively participate in integrated team care management rounds
- Identify related risk management quality concerns and report these scenarios to the appropriate resources
- Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
- Participate in case management committees and work on special projects related to case management as needed
- Assure compliance with NCQA guidelines and covered service guidelines for complex cases.
RN Case Manager – MD office
JSA – Health Care Partners – West Colonial Orlando, FL
06.2016 - 01.2017
- Working as a Care Manager for JSA – Health Care Partners – West Colonial Orlando, FL
- Duties as follows: Assist with the monitoring of utilization management and make recommendations regarding effectiveness of health care resources, trending and intervention
- Monitor inpatient, outpatient, and SNF patients and initiate patient care arrangements
- Report findings to Medical Management, Medical Director and Center Administrator
- Responsible for patient care management to assure appropriate care is provided; reinforce patient education regarding preventative care, dietary restrictions, medications and other therapeutic regimens; coordinate home health and DME requests and provide recommendations to the Center Medical Director
- Provide oversight in patient care evaluation, coordinate the collaboration of the Primary Care Provider and Consultants, and make suggestions to improve plans to meet patient needs
- Assist in the assessment of clinic operations and make recommendations as necessary
- Assure compliance with HCFA guidelines and covered service guidelines
- Assist with the contestation of Part A and Part B claims as needed
- Consistently apply guidelines to the medical record review process
- Evaluate and recommend health delivery network changes with the site 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.
RN Care Manager /Triage – Acute Nurse
Family Physicians Group Kissimmee, FL
12.2012 - 06.2016
- Working as a RN Care Manager /Triage – Acute Nurse for Family Physicians Group Kissimmee, FL
- Duties as follows: Makes initial assessments regarding patient treatment plans and establishes collaborative relationships with physician, advisors, clients, patient, and providers
- Work independently in accomplishing assignments, program goals and objectives to better serve the client
- Serves as the clinical liaison with hospital, clinical staff, coordinates with skilled nursing facilities and with inpatient facilities as well
- Ensures that members receive the proper levels of care, coordinating their care, and assesses and interprets needs and requirements, in addition to referring patients to disease or case management programs
- Makes 'welcome home' call to ensure that discharged members receive the necessary services and resources
- Under general supervision, is responsible to assist the Physician, PA, or NP in support of medical care of urgent care patients
- Day to day activities will vary from triage, answering phones, taking medical histories, to performing lab work, administering IV’s
- Work closely with the Physician, PA, or NP to receive guidance and instruction for treating patients
- Perform selected nursing and administrative duties
- Demonstrates high level of interpersonal and communication skills necessary to consistently receive and greet visitor, patients, and staff members in a professional manner
- Work independently in accomplishing assignments, program goals and objectives to better serve the client
- Serves as the clinical liaison with hospital, clinical staff, and patient
- Ensures that members receive the proper levels of care, coordinating their care, and assesses and interprets needs and requirements.
Education
Bachelor of Science in Nursing -
University of Puerto Rico – Medical Science Campus
06.1987
Skills
- Bilingual written and verbal (English/Spanish)
- Fluent in Spanish
- Computer Skills (Microsoft word and excel, Google forms)
- Work with electronic medical records systems (TruCare platform)
- Problem solving
- Strong time management
- Fluency in ICD codes
- Email management
- Empathy
- Commitment
- Team communication
- Task delegation and management
- Strong organizational skills
- Prioritization
- Creativity
- Health Promotion
- Medication and IV administration
- Direct Patient Care
- Patient Assessments
- Licensed RN
- Care Plan Development
- Patient Management
- Patient and family advocacy
- EMR Systems
- Wound Care
- Chronic Disease Management
- Preventive health
Certification
CCM Certified - 4262026
License
FLORIDA RN License – COMPACT
Languages
Spanish
Native or Bilingual
Timeline
RN Care Manager - Remote
Better Health Group
04.2022 - 03.2024
RN Care Manager II
Sunshine Health Plan
06.2017 - 03.2022
RN Case Manager – MD office
JSA – Health Care Partners – West Colonial Orlando, FL
06.2016 - 01.2017
RN Care Manager /Triage – Acute Nurse
Family Physicians Group Kissimmee, FL
12.2012 - 06.2016
Bachelor of Science in Nursing -
University of Puerto Rico – Medical Science Campus