JOSEPHINE LACSAMANA
Fontana,CA
Summary
Hardworking and dedicated to achieving desired case outcomes. Offers excellent problem-solving, conflict resolution and communication abilities. Highly motivated professional demonstrates ability to develop and implement successful plans of action to address individual needs. Possesses strong problem-solving skills to reduce barriers. Committed to helping individuals and families.
Overview
20
20
years of professional experience
Work History
Inpatient Case Manager/Afterhours
MEDPOINT MANAGEMENT
06.2022 - Current
- Perform clinical review upon admission and daily while patient is hospitalized
- Monitor inpatients stay to prevent delays in services and/or report aberrancy’s
- Adhere to professional standards as outlined by protocol, rules, and regulation
- Responsible for the proactive management of acutely and chronically ill patients with the objective of improving quality outcomes and decreasing costs
- Evaluates and provide feedback for treating physician and/or UM nurses regarding member’s discharge plans and available covered services including identifying alternative levels of care and quality of care that maybe covered
- Performs telephonic concurrent review on all inpatient cases and appropriates ancillary services such as DME, home health services, HLOC etc
- While monitoring and maintaining level and quality of care
- Demonstrates knowledge of assigned cases and presents patient status updates which address barriers to discharge/transition/safety of the patient
- Arranging transportation services when necessary and authorized
- Evaluating clinical files ongoing and insuring care is medically necessary
- Utilizing effective oral communication, written communication and organization skills and demonstrate the ability to prioritize case activities
- Coordinate and provide care that is safe, timely, effective, efficient, equitable and client-centered
- Handle case assignment, draft service plans, review case progress and determine case closure
- Facilitate multiple cases aspects (case coordination, information sharing, etc.)
- Helps patient make informed decisions by acting as their advocate regarding their clinical status and treatment options
- Develop effective working relation and cooperate with medical team throughout the entire case management process
- Monitor all utilization report, daily census, pending cases to assure compliance with turnaround times and decrease length of stay
- Consults with attending physician, health care providers and outside ancillary agencies regarding continued care/treatment if medically necessary to ensure appropriate discharge planning needs are met
- Identifies and recommends opportunities to cost saving and improving quality of care and discharge planning need across the health care continuum
- Demonstrates proficiency in utilizing medical necessity, guidelines
- Understanding of goal of length of stay related to the procedure and diagnosis of IP cases
- Actively works with facility nurses as part of DCP to locate SNF bed, home health agencies, dialysis chair/facilities to delays in discharge and minimize LOS
- Upon identification of non-responsiveness of facility CM to find placement aggressively leads placement of patient to avoid delays in discharge
- Directs and coordinates are interdisciplinary approach to support continuity of care to minimize readmission
- Provides utilization management, transfer coordination, discharge planning and issuance of all appropriate authorization for covered services
- Demonstrate knowledge of discharge planning and demonstrates proficiency of adequate discharge planning for assigned cases
- Responsible for the early identification and assessment of member for potential inclusion in the comprehensive case management program and refer member of care transition LAVCC for intervention and follow up treatment
- Actively closes cases upon notification that identified as primary Medicare or other insurances or carve out services
- Clarifies health plan medical benefits, policies and procedure for member, physician and contact ancillary provider as needed.
AFTERHOURS/TRIAGE CASE MANAGER
PROSPECT MEDICAL GROUP
04.2021 - Current
- Provided professional nursing assessment
- Responded promptly to each incoming calls
- If call warrants a triage, the caller’s stated symptoms will be assessed to determine the appropriate level of care required to safely meet the patient’s medical needs (emergent, urgent, non-emergent or home care status, stable or not stable)
- Utilize all resources and guidelines at his/her disposal to effectively assess, prioritize, advise, physician appointments or refer calls when necessary to the appropriate medical facility, personnel, or specialized community services
- Thoroughly complete documentation utilizing the appropriate computer software in compliance with the approved policies and procedures
- Fax all completed authorization to appropriate hospitals and physician immediately by internal fax
- Approved admission, provided authorization and obtained approval from RMD if deemed necessary for HLOC transfer
- Assess incoming calls for admissions using Milliman Care Guidelines assure appropriate level of care of inpatient care
- Identify and resolve barriers or potential barriers to a safe transition/discharge.
Inpatient Case Manager/Afterhours
REGAL MEDICAL GROUP
02.2017 - 06.2022
- Perform clinical review upon admission and daily while patient is hospitalized
- Monitor inpatients stay to prevent delays in services and/or report aberrancy’s
- Adhere to professional standards as outlined by protocol, rules, and regulation
- Responsible for the proactive management of acutely and chronically ill patients with the objective of improving quality outcomes and decreasing costs
- Evaluates and provide feedback for treating physician and/or UM nurses regarding member’s discharge plans and available covered services including identifying alternative levels of care and quality of care that maybe covered
- Performs telephonic concurrent review on all inpatient cases and appropriates ancillary services such as DME, home health services, HLOC etc
- While monitoring and maintaining level and quality of care
- Demonstrates knowledge of assigned cases and presents patient status updates which address barriers to discharge/transition/safety of the patient
- Arranging transportation services when necessary and authorized
- Evaluating clinical files ongoing and insuring care is medically necessary
- Utilizing effective oral communication, written communication and organization skills and demonstrate the ability to prioritize case activities
- Coordinate and provide care that is safe, timely, effective, efficient, equitable and client-centered
- Handle case assignment, draft service plans, review case progress and determine case closure
- Facilitate multiple cases aspects (case coordination, information sharing, etc.)
- Helps patient make informed decisions by acting as their advocate regarding their clinical status and treatment options
- Develop effective working relation and cooperate with medical team throughout the entire case management process
- Monitor all utilization report, daily census, pending cases to assure compliance with turnaround times and decrease length of stay
- Consults with attending physician, health care providers and outside ancillary agencies regarding continued care/treatment if medically necessary to ensure appropriate discharge planning needs are met
- Identifies and recommends opportunities to cost saving and improving quality of care and discharge planning need across the health care continuum
- Demonstrates proficiency in utilizing medical necessity, guidelines
- Understanding of goal of length of stay related to the procedure and diagnosis of IP cases
- Actively works with facility nurses as part of DCP to locate SNF bed, home health agencies, dialysis chair/facilities to delays in discharge and minimize LOS
- Upon identification of non-responsiveness of facility CM to find placement aggressively leads placement of patient to avoid delays in discharge
- Directs and coordinates are interdisciplinary approach to support continuity of care to minimize readmission
- Provides utilization management, transfer coordination, discharge planning and issuance of all appropriate authorization for covered services
- Demonstrate knowledge of discharge planning and demonstrates proficiency of adequate discharge planning for assigned cases
- Responsible for the early identification and assessment of member for potential inclusion in the comprehensive case management program and refer member of care transition LAVCC for intervention and follow up treatment
- Actively closes cases upon notification that identified as primary Medicare or other insurances or carve out services
- Clarifies health plan medical benefits, policies and procedure for member, physician and contact ancillary provider as needed.
IP CASE MANAGER
SYNERMED (Monterey Park)
04.2015 - 01.2017
- Collaborate with Physician, directors, and health care provider to identify and implement innovative models and best practice that emphasize services improvement service and cost reduction
- Developed and build relationships with contractors, provider and be liaison between group
- Ensure compliance with administrative, legal and regulatory/requirements of the health plan contract
- Utilized the nursing processes, assessed, planned, provided, and evaluated nursing care based on staff and patient interviews
- Identified patient’s condition, implemented care and evaluated care providers
- Responsible for the proactive management of acutely and chronically ill patient with the objective of improving quality outcomes and decreasing costs
- Evaluates and provided feedback to treating physician and/or UM nurses regarding members discharge plans and available covered services including identifying alternative levels of care and may covered
- Clarifies health plan medical benefits and contract ancillary providers as needed
- Arranging HH
- DME, SNF placement for discharge planning
- Work directly with patients to achieve positive health outcomes, through assessment, planning, implementation, and evaluation of patient care plans.
LVN/CNA
GARDEN VIEW POST-ACUTE REHAB
06.2004 - 03.2015
- Carrying out routine care procedures such as administering medication and treatment schedules
- Assist RN in admission and discharge such as medication reconciliation and other administrative task
- Supervising Nurse Assistant to ensure proper care deliver consistently and provide to the patients
- Always Practicing HIPAA compliance
- Provide nursing care to all patient of all ages
- Documents nursing observations according to hospital charting standard
- Reports symptoms, reactions, and progress of patient to the clinical supervisor and/or charge nurse
- Utilizes educational opportunities within the hospital and other avenues to maintain clinical expertise to promote personal growth and development.
Education
VOCATIONAL NURSING -
HEAC
La Crescenta, CA05.2011
BS FOREIGN SERVICE -
LYCEUM OF THE PHILIPPINES
12.1992
Skills
- Communication
- Delegation
- Time management skills
- Approachable
- Conflict resolution skills
- Responsible
- Computer skills
Hobbies and Interests
- Dancing
- Cooking
- Watching movies
Timeline
Inpatient Case Manager/Afterhours
MEDPOINT MANAGEMENT
06.2022 - Current
AFTERHOURS/TRIAGE CASE MANAGER
PROSPECT MEDICAL GROUP
04.2021 - Current
Inpatient Case Manager/Afterhours
REGAL MEDICAL GROUP
02.2017 - 06.2022
IP CASE MANAGER
SYNERMED (Monterey Park)
04.2015 - 01.2017
LVN/CNA
GARDEN VIEW POST-ACUTE REHAB
06.2004 - 03.2015
VOCATIONAL NURSING -
HEAC
BS FOREIGN SERVICE -
LYCEUM OF THE PHILIPPINES