Isabel Heredia
Northridge,CA
Summary
To seek and maintain full-time position that offers professional challenges utilizing Interpersonal skills, excellent time management and problem-solving skills.
Overview
14
14
years of professional experience
Work History
Admission / Case Management / D/C Paining
GFW Group
07.2020 - 01.2024
- Responsible for delivering the best quality of patient care
- Leadership while creating a positive and productive environment
- Setting and following standards for operational excellence
- Referral review for admissions
- Census report
- UM Reviews
- Authorization review
- DME Ordering for patients
- Appeal review
- Develop a relationship with outside organizations, including the medical community, referring physicians, and the media
- Case manage/ Authorization Review, and D/C and admission
- Patient QM survey
- Answering phones
- Patient appointments
- Family Survey
- Case management meeting with Family's
- Meeting schedules
- Reviewing eligibility benefits every week
- Cost effect program, Contracting and developing new programs for better quality of care
- Develop case management team, referral team, and billing team.
Admissions
United Care Facilities
01.2015 - 12.2020
- Responsible for delivering the best quality of patient care
- Leadership while creating a positive and productive environment
- Setting and following standards for operational excellence
- Hire and retain qualified staff
- Implement clinical procedure and policy
- Safeguard required compliance with State, Federal and CMS regulations as well as hospital policies
- QM Meetings
- Referral case management
- Deliver strong financial performance
- Plan of Corrections, QM Reports, Safety Programs and Satisfactory Surveys
- Joint Commission Accreditation Achievement
- Re License and credential all 4 facilities.
Quality Management Team / Case Management
Quality Management for High Desert Medical Group
01.2010 - 12.2015
- Quality management with Case Management
- Audit member services complaints with patients / staffing
- Interview and conduct any incidents with staffing / patients
- Review Appeals / Grievances with findings
- Compliance with All policy and procedures
- Training with staff on developing better compliance protocol
- Responsible for delivering the best quality of patient care
- Leadership while creating a positive and productive environment
- Setting a following standards for operational excellence
- Implement clinical procedure and policy.
Social Services Department / Development Department
Antelope Valley Health care
Education
license -
College Of The Canyons
Skills
- Dialysis Experience
- Social Work
- Group Therapy
- Program Development
- Quality Management
- Case Management
Timeline
Admission / Case Management / D/C Paining
GFW Group
07.2020 - 01.2024
Admissions
United Care Facilities
01.2015 - 12.2020
Quality Management Team / Case Management
Quality Management for High Desert Medical Group
01.2010 - 12.2015
Social Services Department / Development Department
Antelope Valley Health care
license -
College Of The Canyons
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