Dora Morales
Tyler,TX
Summary
Compassionate Case Manager accustomed to treating diverse patient needs while managing dynamic conditions. Collaborative professional possessing excellent clinical knowledge and judgment combined with strong documentation and problem-solving abilities. Well-versed in managing emergent cases with poise.
Overview
6
6
years of professional experience
Work History
Case Manager
CHRISTUS Mother Frances Hospital - Tyler
Tyler, TX
10.2022 - Current
- Coordinated the integration of case management functions into the patient care and discharge planning processes, in collaboration with other hospital departments, external service organizations, agencies, and healthcare facilities.
- Coordinated and facilitated patient care progression throughout the continuum of care in an efficient and cost-effective manner.
- Serves as a resource, provides support, and advocates on behalf of the patient regarding treatment decisions and end-of-life issues.
- Closely monitor patient length of stay in regard to the geometric mean length of stay, and communicate and collaborate with appropriate interdisciplinary team members to remove barriers and expedite discharge.
- Assessed needs for discharge planning and continuing care/resource support following discharge; independently makes recommendations to patients and families regarding post-acute level of care needs and options, including: Acute Rehabilitation Placement, Nursing Home or Skilled Nursing placement, Psychiatric or Substance Abuse placement, New Dialysis, Child/Adult/Domestic Abuse, Home Health/Hospice Referrals, Legal issues (adoptions, guardianship), Assistance with Advance Directives, Community Resource needs, Financial Issues/Funding options, DME Referrals and Coordination, Social Determinants of Health.
- Actively participated in clinical performance improvement activities involving length of stay, resource utilization, avoidable days, cost per case, and readmissions.
- Actively participated in multidisciplinary patient care progression rounds.
- Escalated cases as appropriate and per policy to Physician Advisors and/or CM Directors.
Registered Nurse
Christus Trinity Mother Frances Hospital
Tyler, TX
02.2019 - Current
- Documented patient progress notes accurately and efficiently in the electronic medical record system.
- Ensured compliance with regulatory agencies such as The Joint Commission and Centers for Medicare and Medicaid Services.
- Ensured compliance with standards of professional practice as well as state and federal regulations related to health care delivery services.
- Served as a resource for staff regarding issues related to clinical practice guidelines and protocols.
- Provided direct patient care, including administering medications, treatments, and education to patients and families.
Denials Coordinator
Christus Mother Frances Hospital
Tyler, TX
12.2023 - 11.2024
- Reviewed denial letters issued by insurance companies to ensure that they were appropriate and timely.
- Generated reports related to utilization management activities such as length of stay trends, denials rates.
- Evaluated clinical documentation for accuracy and completeness in order to make decisions about coverage determinations.
- Managed appeals for denied services, providing additional information to support medical necessity.
Education
Associate of Science - Nursing
Kilgore College
Kilgore, TX12-2018
Skills
- Care coordination
- Discharge planning
- Patient advocacy
- Electronic medical records
- Regulatory compliance
- Interdisciplinary collaboration
- Conflict resolution
Affiliations
- Director of youth Ministry at Christ the King in Kilgore since 2023
Languages
Spanish
Professional
Timeline
Denials Coordinator
Christus Mother Frances Hospital
12.2023 - 11.2024
Case Manager
CHRISTUS Mother Frances Hospital - Tyler
10.2022 - Current
Registered Nurse
Christus Trinity Mother Frances Hospital
02.2019 - Current
Associate of Science - Nursing
Kilgore College
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