Jessica Aguilar, LVN
San Antonio,TX
Summary
Licensed Vocational Nurse with 8 years working in many areas of healthcare, to include Managed Care- Utilization Management, Clinical Quality Review/HEDIS, Case Management, and Dataraps. Maintains critical thinking skills essential to providing competent and dignified patient care. Interfaces seamlessly with doctors, specialized support services, patients and families. Clear communicator, both written and verbal. Works well independently and within a team. Seeking a new and exciting opportunity that will enable me to use my existing skills in a department in which I have would be able to contribute my learned skilled and gain new ones; while making a positive contribution to the business.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Healthcare Coordinator
WellMed Medical Management - United Health Group
07.2017 - Current
- Improved patient satisfaction by coordinating timely and efficient healthcare services.
- Reduced hospital readmission rates with diligent follow-up and care coordination for discharged patients.
- Facilitated seamless transitions of care by collaborating with healthcare providers, patients, and families on discharge planning.
- Served as a trusted liaison between patients, families, and healthcare teams to facilitate clear communication and understanding of treatment goals.
- Assisted patients in navigating the healthcare system by providing education on insurance coverage, financial resources, and available support services.
Utilization Management LVN
WellMed Medical Management - United Health Group
- Generates referral entries accurately identifying the covered services authorized including ICD-10 coding, service group and appropriate medical terminology
- Collaborates with the Providers to recommend policies, procedures, and standards which affect the care of the member
- Demonstrate understanding necessary to assess, review, and apply criteria
- Answer member and provider questions regarding care and benefits
- Demonstrate knowledge of process flow and UM including prior authorizations, concurrent authorizations and/or clinical appeal and grievance reviews.
Clinical Quality LVN
WellMed Medical Management - United Health Group
- Analyze data, evaluate for possible data integrity and data deficits and document findings
- Analyze and audits for trends to identify any barriers to improvements of rates and create or offer solutions to such
- Works closely with local leadership to execute quality strategies
- Provides reports and monitors performance at local level
- Supports and improves communications between market and corporate departments
- Maintain education, knowledge base of HEDIS/STARs standards and guidelines.
Case Manager
WellMed Medical Management - United Health Group
- Effectively and efficiently manages patients throughout the continuum of care
- Works with discharge planners and assists in the coordination of support services
- Provides education and support to patients and families related to their medical condition, treatments and the importance of following the continuing treatment plan
- Coordinates and oversees the care and services of patients to achieve desired clinical and resource outcome
- Serves as an advocate for patients in dealing with healthcare providers, insurance plans, and community resources
- Acts as a liaison/resource between patient/family and healthcare personnel to ensure necessary care is provided.
Intake LVN
WellMed Medical Management - United Health Group
- Coordinates patient care as directed by Providers, Registered Nurses and policies including referrals, transition visits, medications, procedures and follow up
- Telephonically obtains information on chief complaints and symptoms and accurately relays information to Providers
- Participates in implanting established education plans for patients and their families with common health problems
- Monitored Physician patient panels for missing quality measures
- Worked with management to implement quality strategies to meet monthly and yearly measures
- Maintains knowledge of current HEDIS/STARs standards and guidelines to stay up to date.
Clinical Documentation Specialist
Gonzaba Medical Group
01.2016 - 07.2017
- Carefully reviewed patient chart/ records in search of DataRaps codes from Chart Audits and supporting documentation
- Communicated with healthcare staff, including physicians, nurses and other caregivers to explain the importance of accurate and clear documentation
- Maintained a strong knowledge of medical terminology, diseases and conditions and procedures
- Requested further information for clarification purposes to Physicians/Providers regarding missing or unclear health record documentation
- Strategically planned methods to achieve operational goals and targets to meet Metrics for HEDIS/STARS.
LVN II
Gonzaba Medical Group
01.2016 - 07.2017
- Lead Nurse responsible for Oncology Specialty office
- Provided leadership, directions and support to Medical Assistants and LVN's on the issues of outpatient care, medications and scheduling
- Performed patient teaching, medication administration, triaged walk-in patients and triaged calls when needed
- Administer IV Therapy (fluids, IV iron, other IV therapeutic drugs as ordered by MD Assisted doctors with surgeries and non-invasive procedures such as Bone Marrow Biopsies and Therapeutic Phlebotomies.
Sr. Utilization Management Coordinator
Wellmed Medical Group
10.2007 - 01.2016
- Performed as Team Lead of 6 to assume control and maintenance of the Medical Claim Review Team with limited supervision
- Acted as liaison/resource between assigned market, patient, providers as well as the Utilization Management department
- Taking the required time on research and using problem-solving skills for clinical review decisions that are in the best interest of the patient while also assuring the member’s care is maintained and achievable in a cost effective manner by using the appropriate provider network
- Worked closely with all levels of leadership as well as patients in the required review and research of the requesting health care services to more complex issues and cases from authorizations to Patient or Provider disputes
- Responded to patient and provider questions/inquiries regarding benefits or referrals with excellent customer service.
Education
Associate of Science - Licensed Vocational Nurse
Career Point College
San Antonio, TX11.2015
Medical Assisting -
SW School of Business and Technical Careers
San Antonio, TX01.2007
Skills
- Strong customer service skill
- Strong clinical judgment
- Analytical thinking
- Managing deadlines
- Communication
- High Achiever
- Process Improvement
- Solutions Oriented
- Well Organized
- Referral Process/Pre-Certification
Certification
- BLS Certified
- IV Certified
Accomplishments
- WellMed SDR Nurse of the Month July 2023
- United Health Care Bravo Award 11/2021 – Quality Dept. High Productivity Awardee
- United Health Care Bravo Award 10/2021 – Quality Dept. High Productivity and Accuracy Awardee
- United Health Care Ruby Recognition for Quality – 09/2021
- United Health Care Opal Recognition for Quality – 07/2021
- WellMed Northern Hills Clinic Employee of the Month 05/2018
- WellMed Northern Hills Clinic Employee of the Month 12/2017
- United Health Care Bravo Award 10/2017
Timeline
Healthcare Coordinator
WellMed Medical Management - United Health Group
07.2017 - Current
Clinical Documentation Specialist
Gonzaba Medical Group
01.2016 - 07.2017
LVN II
Gonzaba Medical Group
01.2016 - 07.2017
Sr. Utilization Management Coordinator
Wellmed Medical Group
10.2007 - 01.2016
Utilization Management LVN
WellMed Medical Management - United Health Group
Clinical Quality LVN
WellMed Medical Management - United Health Group
Case Manager
WellMed Medical Management - United Health Group
Intake LVN
WellMed Medical Management - United Health Group
Associate of Science - Licensed Vocational Nurse
Career Point College
Medical Assisting -
SW School of Business and Technical Careers