Leila Esmaili

Reporting to CMO, working closely with Executive team, and all department leaders.

Leading Care Coordination and Social Services team of 3 acute hospitals including Queen of the Valley Hospital, Intercommunity Hospital, and Foothill Presbyterian Hospital. Overseeing 90 employees including managers, leads, nurse case managers, case management coordinators, social workers, and support staff.

Ensuring assigned measures and standard processes followed to keep safe care transition, efficient utilization management, LOS, number of daily discharges, throughput, core measures, readmission, denial, post discharge follow up plans, patient relation, staff relation, staff retention, budget, and revenue cycle maintain within desired benchmark.

Pulling data and discussing reports to evaluating the department function and productivity.

Rounding on staff regularly. Keeping department meetings and short huddles to share data and updates. Being transparent and keeping staff aware and accountable.

Emphasizing on priorities and assisting staff throughout the day.

Escalating high risk and complex cases to PA and CMO and discussing plan of care and discharge plan as necessary.

Managing Care Coordination Department of Queen of the Valley Hospital.

Overseeing 25 employees, the daily operation, and productivity, Auditing, pulling data, and reporting the findings to Director of Department.

Holding LOS meetings with CMO and PA and assisting team with recommendations.

Collaborating with nursing, providers, business office, verifiers and admitting department to review denials and audited accounts. Collaborating with Risk Management and patient relation. Working closely with Compliance Officer and PI department to ensure CMS guidelines and policies are in order and followed.

Providing quarterly education sessions to staff.

Recognizing and celebrating success and employees. Promoting building connection to elevate the morale.

Hiring, training, and coaching.

Managing staff timecards, staffing, and daily assignment.

Assisting the Corporate and Meditech team to create CM module and embed IQ within EHR for CM better efficiency.

• Managing the department including day to day function and improving productivity
• Orienting new hired case managers and discharge planners, providing education and guidance as a resource to them Interviewing and participate in hiring, counseling, and yearly evaluation
• Staffing including monthly schedule and daily assignments
• Payroll including daily monitoring of staff time cards and providing feedback to staff as needed in regards with their time card management
• Arranging and leading meetings within CM department and with other departments as needed
• Reviewing 10-20 charts daily to oversee and assist staff moving complex discharge plans forward
• Rounding on staff to monitor efficiency of their work and AIDET. Rounding on patients to ensure quality of care and customer satisfaction maintains and address any gap that is found
• Attending Daily bed huddle, safety huddle, LOS, readmission, efficiency of discharge planning process, and Lead measure meetings regularly. Working collaboratively with unit managers, directors, and administration to improve our processes within organization for higher efficiency
• Conducting 14 audits for CM Department Performance Improvement (PI)
• Working collaboratively with Risk Management and SW Lead to manage complex high risk cases. Act as a resource for social workers in absence of SW Lead and as needed
• Attending and working with Utilization Management (UM) committee discussing concerns about quality of care as appropriately submitted in Peer Referral Form
• Reviewing case management policy and procedures and update as needed. Working closely with accreditation coordinator to maintain regulatory expectation is in place
• Working collaboratively with Care management remote center and patient financial services in Denial management and authorization process for all payers.
• Working with Livanta and Organizational Performance to respond to external concerns and status order related or quality related audits

• Supervising students during clinical rotations, providing immediate feedback on their performance and suggesting areas for improvement when necessary
• Providing nursing skill demonstrations for medication administration, dressing changes and clinical logs
• Instructing students on how to perform head-to-toe assessments on patients and how to intervene in medical emergencies
• Promoting critical thinking among nursing students by introducing complex case studies in post conferences
• Evaluated student progress through written exams, skill demonstrations, and clinical rotations, ensuring they met program requirements

• Floating to all units to case manage as a float CM
• Conducting clinical review, ensuring medical necessity, ensuring authorization status is in order, screening patients, creating care plan, working closely with multidisciplinary team, problem solving, educating pt/families, and documenting
• Working closely with insurance companies and multidisciplinary team including physicians to coordinate acute to acute transfers
• Coordinating placement, outpatient dialysis, DME, HH, Hospice, post DC appointment, obtaining authorization
• Delivering Medicare Important Message and choice Forms

• Teaching and guiding nursing students in registered nursing (RN) program in acute setting (KP Sunset)
• Supervising students during clinical rotations, providing immediate feedback on their performance and suggesting areas for improvement when necessary

• 2004-2010: Trained to float to Intensive Care Units and all Telemetry Units
• 2004-2009: Working as registered staff nurse and relieve charge nurse on Cardiac Intervention Telemetry Unit
• 2009-2010: Working as registered staff nurse on Intensive Care Units

• Maintaining Health record and health assessment of 4-6 year-old, and assist lead teacher in implementing school curriculum

• Assisting nurses in proving care for long term chronically ill patients including all Activity of Daily Living (ADL) and treatment plans

• Assisting an unfortunate tetraplagic young man who lived at home and needed help with ADL to maintain his health and live as independently at home as possible

• Assisting in translation of documents from Farsi to English. Documents included marriage certificate, employment verification, university transcripts, and certificates