Flor Balderas
Albuquerque,NM
Summary
Go to achiever, mentor, peer and patient support.
Community awards.
Overview
2
2
Languages
16
16
years of professional experience
Work History
Senior Telephonic Bilingual Nurse Case Manager
Arissa Cost Strategies
Irvine, CA
04.2020 - 09.2026
- Coordinated care plans to meet patient needs and enhance health outcomes.
- Conducted comprehensive assessments to evaluate patient health and identify gaps in care.
- Collaborated with multidisciplinary teams to streamline communication and improve service delivery.
- Developed educational materials for patients to promote self-management of chronic conditions.
- Monitored patient progress and adjusted care strategies based on evolving situations.
- Implemented quality assurance measures to ensure compliance with healthcare regulations and standards.
- Advocated for patients' needs, facilitating access to resources and support services effectively.
- Educated patients and caregivers on healthcare protocols and processes.
- Managed support services and fostered communication among social workers, therapists, hospital staff, and patients.
- Collaborated with healthcare leaders and physicians to support and offer resources in performance of duties to maintain high-quality and efficient patient care.
- Promoted continuity of care by coordinating with healthcare providers, social workers, and family members in the development of discharge plans.
- Applied critical thinking skills during case reviews to identify potential risks or challenges before they escalated into larger issues.
- Educated patients on disease management techniques, empowering them to take control of their health and reduce complications.
- Optimized resource utilization by identifying opportunities for cost containment without compromising care quality.
- Gathered and recorded patient health information and data to assess, identify and manage characteristics that affect care outcome.
- Facilitated smooth transitions between healthcare settings by effectively communicating pertinent information to receiving facilities or home health agencies.
- Initiated cross-discipline collaboration efforts that led to improved patient outcomes across various departments in the facility.
- Implemented aspects of patient care under physician orders and sought clarification when needed to promote safety, quality and cost-efficient care.
- Evaluated clinical data trends over time, identifying areas requiring process improvements that ultimately led to better overall patient experiences.
- Conducted thorough assessments to identify gaps in care and develop targeted interventions for improvement.
- Improved patient outcomes by developing and implementing comprehensive care plans tailored to individual needs.
- Managed caseloads efficiently, prioritizing high-risk cases while ensuring all patients received appropriate attention and support.
- Advocated for patient needs, addressing concerns with healthcare providers and insurance companies to ensure optimal care was received.
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
- Worked with suppliers and vendors on provision of medical equipment, items and services.
- Used Software to maintain database of relevant information for practitioners to access and coordinate patient care.
- Assessed and examined patients and documented history of current and previous conditions, diseases and injuries along with medications currently being taken.
- Examined patients and documented history of current and previous conditions, illnesses, injuries, and current medications.
- Performed evaluations on consistent basis to address changes in patient needs, conditions and medications, altering care plans when required.
- Negotiated with suppliers and vendors to procure medical equipment, supplies and services.
- Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.
- Performed triage on incoming patients and determined severity of injuries and illnesses.
- Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities.
Clinical Nurse Case Manager
Compassus Hospice And Palliative Care
Albuquerque, NM
02.2013 - 2019
- Administered patient medications and monitored responses to ensure safety and comfort.
- Collaborated with interdisciplinary team to develop comprehensive care plans tailored to individual needs.
- Educated patients and families on disease management, treatment options, and end-of-life planning.
- Conducted regular assessments of patient conditions, documenting changes and communicating with healthcare providers.
- Implemented best practices for infection control and safety protocols in hospice settings.
- Mentored new nursing staff on clinical procedures, enhancing team performance and patient care quality.
- Led quality improvement initiatives that streamlined care delivery processes within the hospice unit.
- Advocated for patients' rights and preferences, ensuring respectful and compassionate end-of-life care experiences.
- Maintained strong working relationships with physicians and ancillary staff, fostering a collaborative approach to patient care delivery.
- Educated patients and families to increase understanding of condition and best ways to manage.
- Collaborated with interdisciplinary teams for optimal patient outcomes and efficient care coordination.
Nurse Case Manager Utilization Review RN
Ardent Healthcare, Lovelace Hospital
Albuquerque, NM
01.2011 - 02.2013
- Coordinated patient care plans to ensure optimal health outcomes and resource allocation.
- Conducted comprehensive assessments to identify patient needs and develop tailored interventions.
- Collaborated with multidisciplinary teams to enhance continuity of care and treatment effectiveness.
- Educated patients and families on disease management, medications, and lifestyle modifications.
- MCG Milliman care guidelines reviews to determine medical necessity, level of care inpatient stays.
- Reviewed appeals decision determinations.
- Vast use of EHR.
- Communicated frequently with physicians, patients, insurance carriers.
- Care coordination. Facilitated discharge planning transition of care, utilized DME.
Education
Bachelor of Science - Nursing, RN-BSN
Eastern New Mexico University
Portales, NMSkills
- Active, unrestricted California RN license, Nevada RN license, and licensed in all multi-state RN compact states
- Proficiency with Microsoft Office (Word, Excel, Outlook)
- Bachelor's Degree in Nursing
- 17 years of clinical case management experience
- 17 year of experience supporting
SNP programs within a health plan environment - Active Multi-state RN licensure in all company markets and California
- Very Strong understanding of CMS SNP Model of Care Medicare Advantage regulations
- Vast care coordination & population health strategies
- I have all of the below vast & preferred qualifications :
- RN-BSN and MSN began
- 10 years of leadership or supervisory experience in managed care or health plan operations
- Vast 17 years experience with utilization review criteria such as MCG guidelines
- Strong leadership and team development capabilities
- Excellent communication and relationship-building skills
- Data-driven mindset with the ability to analyze trends and drive performance
- Experience working with EHR systems and healthcare technology platforms
- Strong organizational, project management, and problem-solving abilities
- Ability to thrive in a fast-paced, collaborative, remote environment
Vast 17 years skills for success:
Languages
English
Native or Bilingual
Spanish
Professional Working
Timeline
Senior Telephonic Bilingual Nurse Case Manager
Arissa Cost Strategies
04.2020 - 09.2026
Clinical Nurse Case Manager
Compassus Hospice And Palliative Care
02.2013 - 2019
Nurse Case Manager Utilization Review RN
Ardent Healthcare, Lovelace Hospital
01.2011 - 02.2013
Bachelor of Science - Nursing, RN-BSN
Eastern New Mexico University