Jorge Perez
Hollywood,FL
Summary
Dynamic Case Manager with extensive experience at University of Miami Hospital and Clinics, excelling in discharge planning and utilization review. Proven ability to enhance documentation compliance and streamline care transitions. Skilled in applying InterQual criteria and fostering interdisciplinary collaboration, while maintaining meticulous attention to detail and ensuring HIPAA compliance.
Overview
27
27
years of professional experience
Work History
Case Manager
University of Miami Hospital and Clinics
Miami, FL
08.2016 - Current
- Lead interdisciplinary coordination between Case Management Supervisors, Social Workers, Admissions, Physicians, and Insurance Companies.
- Perform initial ED case reviews using InterQual; collaborate with Physician Advisor to ensure EMTALA compliance.
- Coordinate discharges for patients not meeting inpatient/observation criteria.
- Manage post-5:00 p.m. case transitions for surgical complications, submitting updated ICD-10/CPT and clinical documentation to insurers.
Case Manager - Per Diem Roles (Weekends)
North Shore Medical Center
Miami, FL
01.2014 - Current
- Provide weekend coverage for discharge planning and insurance authorizations.
- Communicate with interdisciplinary staff and payers to support weekend discharges.
Case Manager
Mount Sinai Medical Center
Miami Beach, FL
01.2014 - 05.2016
- Managed discharges, authorization requests, and inpatient utilization reviews in ICU and telemetry settings.
- Partnered with interdisciplinary teams to streamline throughput and documentation.
Case Manager
North Shore Medical Center
Miami, FL
01.2013 - 01.2014
- Oversaw inpatient caseloads, coordinated discharge plans, and communicated with insurance providers for extended-stay approvals.
Case Manager - Per Diem Roles (Weekends)
Mount Sinai Medical Center
Miami Beach, FL
03.2005 - 12.2013
- Provided weekend case management coverage in inpatient and telemetry units.
- Reviewed documentation, coordinated discharges, and worked with insurance for approvals.
Case Manager
Kendall Regional Medical Center
Miami, FL
04.2005 - 01.2013
- Delivered comprehensive case management for inpatient units.
- Applied InterQual to support medical necessity and authorization reviews.
Case Manager
Coral Gables Hospital
Coral Gables, FL
10.2000 - 03.2005
- Facilitated discharge planning and insurance coordination for medical and surgical units.
- Reduced delays by collaborating with payers and support services.
Utilization Review Specialist
Beacon Health Inc.
Miami, FL
01.1998 - 09.2000
- Managed catastrophic cases requiring extended oversight and benefit exception handling.
- Applied InterQual criteria to evaluate care appropriateness and coordinated with insurers for service approvals.
Education
Ph.D. - Internal Medicine
University of Matanzas
Cuba01.1980
Skills
- Case Management
- Utilization Review
- Catastrophic Case Handling,
- Chronic Complex Care
- Discharge planning
- InterQual Criteria
- ICD-9, ICD-10 /CPT Coding
- Documentation Compliance
- Clinical Documentation and Reporting
- Microsoft Word, Excel, Adobe
- Attention to detail
- HIPAA compliance
Timeline
Case Manager
University of Miami Hospital and Clinics
08.2016 - Current
Case Manager - Per Diem Roles (Weekends)
North Shore Medical Center
01.2014 - Current
Case Manager
Mount Sinai Medical Center
01.2014 - 05.2016
Case Manager
North Shore Medical Center
01.2013 - 01.2014
Case Manager
Kendall Regional Medical Center
04.2005 - 01.2013
Case Manager - Per Diem Roles (Weekends)
Mount Sinai Medical Center
03.2005 - 12.2013
Case Manager
Coral Gables Hospital
10.2000 - 03.2005
Utilization Review Specialist
Beacon Health Inc.
01.1998 - 09.2000
Ph.D. - Internal Medicine
University of Matanzas
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