Summary
Overview
Work History
Education
Skills
References
Certification
Timeline
BusinessAnalyst
Maria Cespedes

Maria Cespedes

Summary

Compassionate and hardworking Registered Nurse with over 15 years of experience in offering comprehensive patient care. Well versed with diverse populations while developing trusting relationships to improve outcomes. Efficiently coordinates with healthcare professionals to advance patient care. Knowledge in intensive care, utilization review, InterQual and case management settings with success in providing individualized patient care.

Overview

15
15
years of professional experience
1
1
Certification

Work History

RN, OUTPATIENT CARE MANAGER

OCHSNER HEALTH
12.2019 - Current
  • Identify complex patients with multiple co-morbidities attributed to the organization and to it network of partner providers
  • Conduct comprehensive health risk assessments telephonically to evaluate the individual's medical, psychosocial, behavioral, cultural and/or spiritual needs to develop a plan of care focused on disease managed conditions
  • Educate patients on their medical conditions and symptoms
  • Regularly contact patients to discuss their patient centered treatment plan, answer patient questions and concerns
  • Document and update on daily case notes and coordinated follow ups through case management process
  • Interact with all interdisciplinary members of the healthcare team to help coordinate and maintain the most appropriate level of care for patients
  • Work with patients, their families and or caregivers to create a comprehensive treatment plan complete with specific goals and objectives
  • Monitor and evaluate the effectiveness of the individualize care plan to enable patients to achieve self management of the healthcare
  • Change and modify care plan as needs and situations present through evidence-based therapeutic interventions and crisis management
  • Attend and participate in weekly case review presentations to discuss problems and unique issues while sharing professional support and feedback aimed toward improving patient care
  • Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
  • Liaised with social worker to expedite financial assistance not covered by insurance.


RN, CASE MANAGER, NICU/PEDS CASE MANAGER

AETNA BETTER HEALTH OF LA
02.2016 - 12.2019
  • Utilize advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for members
  • Conduct comprehensive health risk assessments telephonically to evaluate the individual's medical, psychosocial, behavioral, cultural and/or spiritual needs to develop a plan of care focused on disease managed conditions
  • Present complex cases during integrated rounds to interdisciplinary care team and medical director(s) to facilitate appropriate treatment for members while inpatient and following discharge with multidisciplinary focus
  • Complete home based, hospital, physician office visits etc as pertinent to members conditions Participate in direct provider coordination/collaboration to promote optimal member functioning and cost effective outcomes
  • Act as interpreter and communicate with members who were Spanish speaking solely
  • Communicate with services providers (DME, home health etc) to ensure member had sufficient supplies and coordinate prior authorizations were submitted on member's behalf
  • Guide and educate members and their families toward and assist with interaction with community resources, plan benefits, and resources options appropriate for the care and wellbeing of members
  • Sole NICU/PEDS Case Manager for the state of Louisiana (received NICU referral from UM consultant following birth)
  • Referred member to PDHC (Pediatric Day Healthcare Center) for medically fragile members and maintain contact with DON (Director of Nursing) regarding members enrolled
  • Communicate with the member and/ or care giver to assist with the development of health goals and identify interventions to achieve these goals
  • Arrange and manage transitions in care; such as transition from hospital to home working collaboratively with hospital staff (social worker, case manager and or discharge planner)


RN, PEDIATRICS AND CASE MANAGEMENT

CHILDREN'S HOSPITAL
08.2007 - 01.2014
  • Managed care for newborns, infants and children in critical (NICU and Spinal Unit and med-surgical settings)
  • Developed and documented patient care plans, including assessments, evaluations, nursing diagnoses, discharge care for newborns, infants and children
  • Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions
  • Consulted and coordinated with healthcare team members to assess, plan, implement, or evaluate patient care plans
  • Collaborated with the interdisciplinary team to implement the plan of care and transition strategies
  • Ensured the achievement of desirable patient outcomes with terms of an appropriate length of stay, efficient utilization of resources, patient/family/staff education
  • Reviewed new patient admission to meet InterQual criteria, communicated necessary changes to ordering physicians and submitted reviews to insurance companies and or Medicaid entities
  • Communicated with physicians, any interdisciplinary team member, and third-party payers regarding inpatient stays
  • Performed utilization management activities to avoid denials and control cost where possible
  • Acted as interpreter between family and healthcare team members
  • Monitored patients by observing and evaluating treatments and responses, advocated for needed services, obtained additional resources when necessary
  • Improved staff competence through educational resources to facilitate new patient admittance

TELLER/CSR

GULF COAST BAND AND TRUST, OMNI BANK, FIRST BANK AND TRUST
08.1998 - 12.2010

Education

Associate of Nursing -

Charity School of Nursing
New Orleans, LA
01.2008

Skills

  • Patient and family focused
  • Strong clinical judgement
  • Culturally competent
  • Bilingual (Spanish)
  • Detail oriented and able to work independently
  • Patient education and counseling
  • Chronic Disease Management
  • Care Planning

References

Available upon request

Certification

  • LSBN Licensure-December 2008

Timeline

RN, OUTPATIENT CARE MANAGER

OCHSNER HEALTH
12.2019 - Current

RN, CASE MANAGER, NICU/PEDS CASE MANAGER

AETNA BETTER HEALTH OF LA
02.2016 - 12.2019

RN, PEDIATRICS AND CASE MANAGEMENT

CHILDREN'S HOSPITAL
08.2007 - 01.2014

TELLER/CSR

GULF COAST BAND AND TRUST, OMNI BANK, FIRST BANK AND TRUST
08.1998 - 12.2010

Associate of Nursing -

Charity School of Nursing
  • LSBN Licensure-December 2008
Maria Cespedes