Elizabet Rodriguez

Working remotely

• Provide necessary coordination and follow-up of information with clients, their family members, physicians, referral sources, agency staff, and others involved in assuring timely initiation of and continuity of care.
• Ensure referral/physician orders, and other documents as needed, are appropriately documented in patient' EMR.
• Collaborate with client, physician, referral source, sales, and/or local agency operations to collect information needed to process a referral.
• Provide and/or secure data to local agency operations and sales team(s) to resolve aging referrals.
• Provide data to agency operations and sales team(s) that will assist in determining admission decisions for pending referrals.
• Document all referral related data, actions taken, and follow-up required in EMR in timely and accurate manner.
• Request face-to-face (FTF) encounter documentation, H&P, Discharge Summary, and other documents needed for ICD-10 coding, if not received with the referral information.
• Inform referral sources, clients, family members, and physicians about clinical and non-clinical programs available in home setting, as requested.
• knowledge: ARC EPIC, BSW EPIC, Allscripts, NAVI,HCHB, Forcura.
• Bilingual: English/Spainish

• Working remotely
• Identify special needs members through completion of health screens and other resources
• Work with community outreach/member advocates to coordinate member care
• Educate providers and community resources on program components and available support services
• Educate members with special needs to foster compliance with program and positively impact outcomes
• Develop and modify care plans in conjunction with member, member’s family and managing physician
• Development of plan specific literature and education materials in conjunction with medical director and corporate oversight.

• Working remotely
• Special needs members through the completion of health screens and other resources
• Work with community outreach/member advocates to coordinate member care
• Educate providers and community resources on program components and available support services
• Educate members with special needs to foster compliance with program and positively impact outcomes
• Develop and modify care plans in conjunction with member, member’s family and managing physician
• Development of plan specific literature and education materials in conjunction with medical director and corporate oversight.

• Coordinating and managing the care of our home health patients.
• Triage all patients calls and provide medical direction and care, by responding to all communications.
• Track PT INR Management Process Lab/Diagnostic Imaging orders including initiation of Urgent orders as directed by Providers.
• Explained upcoming treatment preparation, instructions and other facts to Lab results and medication changes to patients.
• Report critical/abnormal values to providers.
• Serve as a Clinical Liaison between Providers, Patients, Families, Assisted Living Communities.
• Oversee indirect healthcare to patients such as: wound care, medication administration, Vital signs and all laboratory procedures.

• Receive, document, and key into computer system all incoming patient referrals via telephone, facsimile, or other source.
• Screens referrals for eligibility for hospice services Perform data entry accurately resulting in accurate electronic data reference files.
• Arranges DME, supplies and medications Obtain doctor's orders.
• Add new physicians to computer system; Check UPIN and credentials.
• Schedule admission nurse visits using Outlook Report maintenance using Microsoft Excel Serve as Liaison between Agency and physicians, hospitals, clinics.
• Apply knowledge of Medicare eligibility criteria, agency admission policies, and community resources.
• Highly organized and enthusiastic; able to prioritize effectively to ensure initial and follow up treatments are completed.
• Good communication skills/phone skills.
• Consultations with Spanish speaking patients and families at homes, hospitals, and office.
• Insurance Verification.
• Bilingual- English & Spanish

• Administration of medications
• Injections
• Neb Tx Feeding tubes
• Skin assessments
• Medicare charting
• Skilled Nursing
• Admissions
• Incident reports.
• Performed various nursing interventions such as wound dressing, vital sign monitoring and specimen collection.
• Monitored patients' conditions and reported changes in physical ability, appearance and behavior to discuss treatment with physicians.
• Assessed physical, psychological, physiologic and cognitive status of patients.
• Identified patient care requirements by establishing personal rapport with patients and families.