Summary
Overview
Work History
Education
Skills
Accomplishments
Timeline
Generic

Lisbeth Garza

Roma

Summary

With a background of 7 years in clinical, social and health service care management, Iam well equipped to assist the Medicare and Medicaid populations and to guarantee adherence to all applicable federal and state regulations. I have the capacity to offer a wide range of patients from children to adults with special needs. I am a motivated HSS Clinical Coordinator RN with a proven record in excelling in clinical coordination and patient advocacy. Experienced in providing resources and health education to improve the well being of individuals and their families within the community . I am an adaptive learner and enjoy learning new skills. i am eagerly seeking a position as a LTSS Service Coordinator RN within Superior MCO. I am ready for a new challenge and opportunity to gain experience within the organization.

Overview

7
7
years of professional experience

Work History

HSS Clinical Coordinator RN

United Healthcare
07.2024 - Current
  • Perform comprehensive LRSS member assessments including MNLOC,RASM, ILR, upgrades and other health assessments as required to comply with state and Federal guidelines.
  • Perform home face-to-face, Virtual and Telephonic member assessments in order to identify members' strenghts and needs which will help to create a plan of care to close any gaps in member care.
  • Educate members and family on community resources including LTSS services, referral for PCP, specialists and services within the community.
  • Create holistic care plans that are member-centered to identify short and ling term goals that are important to and for a member to remain in the community setting and evaluate the plan of care during every member's touchpoints.
  • Submit MCO-required documents in a timely manner to ensure deadlines are met while following MCO, state, and federal guidelines.
  • Communicate and coordinate with different members of the healthcare team to ensure closure of any gaps in members' needs, including needs for DME, therapy, transportation, housing, and other resources.


Health and Social Services Clinical Coordinator RN

United Healthcare
12.2017 - 06.2024
  • Performed comprehensive health care evaluations for Annual, Significant Change in Condition, and Initial Assessments for the Star Kids level 1,2, and 3 members within the community.
  • Identified problems and provided solutions to member's issues that could have led to gaps in members' care.
  • Collaborated closely with the interdisciplinary team members ti coordinate care for member's treatments to ensure member service/care needs were met and determine a revised care plan/service plan for the member if needed.
  • Planned, and managed within my caseload while providing education on measures to prevent health complications.
  • Perform home and/or other site visits to assess member’s needs and collaborate with healthcare providers and partners.
  • Collected, documented, and maintained all member information and care management activities to ensure compliance with current state, federal, and clinical guidelines

Education

Bachelor of Science - Nursing

Capella University
02-2024

Certificate - RUG Certified

Texas State University
11-2023

Associate of Science - Nursing

South Texas College
05-2017

Skills

  • Clinical coordination
  • Care planning
  • Healthcare management
  • Patient advocacy
  • Interdisciplinary collaboration
  • Time management
  • Communication skills
  • Critical thinking
  • Care coordination
  • Team collaboration
  • Problem solving
  • Patient-centered care

Accomplishments

  • Earned numerous of BRAVO awards for collaboration, Performance and Leadership.
  • NPS Champion Certification
  • SAGES nominee
  • Health Plan Culture Ambassador
  • Participated in the UTR workgroup.
  • Participated in Translation workgroup.

Timeline

HSS Clinical Coordinator RN

United Healthcare
07.2024 - Current

Health and Social Services Clinical Coordinator RN

United Healthcare
12.2017 - 06.2024

Bachelor of Science - Nursing

Capella University

Certificate - RUG Certified

Texas State University

Associate of Science - Nursing

South Texas College

Similar Profiles

CREATE PROFILE
Lisbeth Garza