Imelda Samonte

Facilitate patient care by assessing patient needs, evaluating treatment options, creating treatment plans and coordinating care with interdisciplinary team.

Helps identify appropriate providers and facilities throughout the continum of services.

Ensuring available resources are being used timely and cost effective in order to obtain optimum value for both the client and reimbursement source.

Directly work with patients and their families to put care plan in place.

Advise patients on treatment options and clinical status, advocate for personalized care.

Provide education and guidance to patients and their families on complex medical decision.

Collaborate with interdisciplinary team to ensure that patient receive consistent, high-quality care.

Facilitated successful transitions from acute care settings to post-acute environments by coordinating with appropriate providers and services.

Enhanced patient satisfaction by conducting regular assessments, addressing concerns, and promptly resolving issues.

Promoted culture of safety by participating in quality improvement initiatives, identifying areas for improvement, and developing action plans.

Served as liaison between patients, families, medical providers, and insurance companies to ensure efficient coordination of care resources when needed.

Actively participated in interdisciplinary rounds to contribute valuable insights from a nursing perspective while discussing patient progress and care strategies.

Evaluated patient experiences using survey data to identify opportunities for improving service delivery across all aspects of care provision.

Monitored patients, evaluated results, and recommended further courses of treatment to quickly improve patient outcomes.

Improved patient outcomes by implementing evidence-based clinical practices and providing ongoing education to nursing staff.

Reduced hospital readmissions through thorough discharge planning and coordination with interdisciplinary teams.

• Perform daily prospective, concurrent, and prospective review using evidence-based guideline criteria, (MCG and Interqual)and other information to determine appropriate level of care and readiness for discharge.
• Utilize evidence-based practices and clinical guidelines to inform decision-making and improve patient outcomes.
• Support ED staff and physician in identifying unnecessary admission, arrange for appropriate referrals and follow up for outpatient service
• Advocate for patients and their families to ensure they receive the highest quality of care.
• Manage complex cases, including those involving multiple commodities and social determinants of health.
• Provide comprehensive care coordination and management for patients with complex medical needs.
• Develop and implement individualized care plans that address patients' physical, emotional, and social needs.
• Collaborate with interdisciplinary teams to ensure continuity of care and optimal patient outcome.
• Worked closely with physician and Health plan regarding denials, facilitate appeal process initiate peer to peer as needed.
• Worked with senior physician leaders when physician to physician conversation will require (Escalated cases to senior physician when MD to MD conversation is required)
• Establish a partnership with a high-volume health plan including weekly calls to decrease denials, enhance communication, and to optimize timely authorization and insure re-reimbursement.
• Advised and supported physician regarding documentation to support inpatient stay.
• Establish a partnership with the physician to improve clinical documentation, reduce length of stay, and ensure a safe discharge to the next level of care without delay in service discharge planning and transition.
• Educated patients on available community resources and how to access them effectively to prevent re-admission.
• Participated in team meetings to discuss case management strategies for individual cases.
• Participate in daily departmental hurdles to create sustainable clarity and focus within the team to achieve LOS/organizational goals.
• Collaborate with physician and department director to the development and improvement of clinical care pathway that enhance cost effectiveness while providing quality care
• Worked with community partners (HH, SNF, Hospice) to assist patients in safe and appropriate next level of care.
• Review denied claims from all payers related to medical necessity appropriate setting/status determination, authorization, and appropriate length of stay.
• Ensure all denied claims are accurately worked and appealed to obtain maximum reimbursement and minimize recoupment.
• Communicate with the hospital providers regarding missing or insufficient documentation.
• Ensure that all appeals are filed in a timely manner.

• Managed day-to-day workflow within the department, delegating tasks appropriate
• Coordinated patient Care activities between medical teams, providing guidance and support to nursing staff
• Utilize effective communication skills to collaborate effectively with staffs, physicians an other health Care professional
• Ensure compliance with all applicable state and federal laws governing health Care facilities.
• Assisted with recruitment efforts by interviewing potential candidates for open position in nursing department.
• Reviewed incident reports submitted by nursing staff members, taking corrective action when necessary
• Initiated process improvements to enhance operational effectiveness while maintaining quality control standards
• Demonstrated expertise in developing and managing nursing staff, ensuring high quality patient care.
• Participated in strategic planning initiatives to promote growth within the organization.
• Established clinical direction for nursing care delivery, providing clinical supervision and maintaining quality outcome.
• Advocated for patients and families, liaising with multidisciplinary teams.
• Cooperated with other health care professional to develop and implement policies and procedure to promotes patient safety and quality of care
• Managed 150 nurses and nursing activities in 120 -bed Skilled Nursing Facility by providing comprehensive nursing guidance and maintaining outstanding patient satisfaction and standards.