Maira Vazquez-Agosto
Forsyth,FL
Summary
R.N. with 20+ years of experience in various healthcare industries. 15 years working in the insurance companies business acumen and as Care Management. Eager to contribute my nursing expertise and my skill set in various medical management systems. To provide quality care to help achieve goals and objective to the company.
Overview
18
18
years of professional experience
Work History
Care Manager, Telephonic Nurse 2
Humana, Inc.
03.2010 - Current
- Assisted in conducting needs assessments to identify key areas of service needs.
- Facilitated communication between clients and other service providers.
- Collaborated with various stakeholders to promote social services.
- Participated in meetings with stakeholders and providers to discuss program objectives and strategies.
- Identified high utilizers patients accessing ER and collaborative with providers to discuss on strategies on optimal care of the patient and to reduce cost.
- Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers.
- Ensure work with Quality Team on compliance with Medicare guidelines.
- Negotiate with suppliers and vendors to procure medical equipment, supplies and services according to patient benefit coverage and contracts with vendors.
- Coordinate with interdisciplinary professionals to develop plans of care to provide the best outcome for the patient.
- Manage and streamline referral queues as to prioritize patients and clearing insurance obstacles.
- Liaison for physicians regarding patient needs, performance and changes.
- Utilize MCG database and other electronic information data platform to attain relevant information for coordination of patient care.
Senior Community Health Nurse/Case Manager
State of Florida
09.2007 - 01.2010
- Case Managed clients being discharge from hospital settings. Assisted in coordination of care for the best outcome of the client.
- Received referrals from other agencies for clients to be enrolled in our program.
- Worked with other interdisciplinary personnel as a team to coordinate the need of the client.
- Completed assignments in a timely manner, followed through on assignments, and used time effectively; act independently.
- Developed and maintained effective working relationship.
- Treat customers, the public, and other team members with courtesy, respect, dignity, fairness, honesty, and present a positive public image.
- Produced reports, correspondence, and other work products which meet the intended objectivity, demonstrate professional competency, and reflect acceptable quality.
- Collaborated with other health-focused organizations and agencies to promote community health.
- Implemented accurate and timely documentation in electronic client medical records.
- Delivered high level of quality care to diverse populations while overseeing patient admission and triaging based on acuity and appropriate department admission.
- Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.
- Led teams in driving successful patient outcomes by prioritizing standard of care and best practices.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
Charge Nurse, Urgent Care Clinic
Premier Community Health Care Group, Inc
, FL
02.2006 - 08.2007
- Skilled nursing services, treatments and preventive procedures ordered by physician and other providers.
- Used MISYS computer system and worked with billing/coding.
- Serve as a Preceptor for other staff.
- Managed office and other staff personnel.
- Produced reports, correspondence, and other work products.
- Worked in direct collaboration with other physicians and referred patients accordingly to best support health care needs.
- Analyzed complex trauma conditions and quickly determined treatments for various illnesses and injuries.
- Coordinated and integrated health care resources for community-based programs.
- Trained support staff in patient care strategies, intake requirements and requirements for assisting with different procedures.
Skilled R.N. Team Leader
Home Care Of Rochester, Inc.
, NY
01.2005 - 01.2006
- RN team lead for a new initiative program serving the Hispanic population.
- Provided my expertise in Nursing /CM in the expansion of the services to Hispanic patients in collaboration with HCR’s clinical management.
- Provided and coordinated quality patient care primarily within the Hispanic community . Additionally maintained a number of cases , maintained productivity goals with consideration of case mix, and accurate, timely documentation in the electronic medical record system.
- Assisted in recruitment of interdisciplinary professionals to serve the Hispanic population patients.
- Collaborated with local providers and provided presentations about the Hispanic Initiative program.
- Built strong relationships with customers through positive attitude and attentive response.
- Conducted training and mentored team members to promote productivity, accuracy, and commitment to friendly service.
Education
B.S.N -Currently Enrolled in Program
Spalding University-Currently Enrolled B.S.N Prog.
Louisville, KYAssociate - Nursing
Monroe Community College (MCC)
06.1995
Skills
- RN Case Management
- Electronic Health Records Management
- Healthcare Ethics
- Microsoft Office
- Manage Cases
- Accurate Documentation
- Insurance Plan Verification
- Insurance Industry Experience
- Prior Authorization
- Milliman Care Guidelines (MCG)
- Organization and Time Management
- Teamwork and Collaboration
- Planning and Coordination
- Multitasking Abilities
- Database Searches
- Attention to Detail
- Verbal and Written Communication
- Analytical Thinking
- Insurance Claims and Denial Processes
- Patient Diagnosis
Languages
Spanish
Native or Bilingual
Timeline
Care Manager, Telephonic Nurse 2
Humana, Inc.
03.2010 - Current
Senior Community Health Nurse/Case Manager
State of Florida
09.2007 - 01.2010
Charge Nurse, Urgent Care Clinic
Premier Community Health Care Group, Inc
02.2006 - 08.2007
Skilled R.N. Team Leader
Home Care Of Rochester, Inc.
01.2005 - 01.2006
B.S.N -Currently Enrolled in Program
Spalding University-Currently Enrolled B.S.N Prog.
Associate - Nursing
Monroe Community College (MCC)