Maria Rassi
Lake Worth,FL
Summary
Experienced healthcare professional seeking a challenging position that will provide a means to use the full extent of my experience in the Health field. In order to provide aide to patients and the organization, along with paths for advancement.
Overview
37
37
years of professional experience
Work History
Community Associate
Blue Cross of Blue Shield Florida
01.2021 - Current
- Retrieved, prioritized, and responded to in-bound referrals and consults requested to provide assistance to members
- Educates members on benefit plan impacts and available choices, facilitating benefit savings and promoting informed healthcare decisions
- Maintained telephonic communication with members to ensure their needs and/or issues are addressed
- Facilitated benefit savings for members by proactively educating regarding benefit plan impacts and choices available to their Health or Pharmacy plan
- Retrieved and analyzed Care program and Social Service referrals as the initial point of contact for incoming referrals in mailboxes, voicemails, and reports, and distributed to appropriate program for engagement by nursing staff
- Communicated and collaborated with internal and external staff members including initiating referrals to Case Management or Social Services for members interested in program participation
- Supported continuous improvement efforts through the early identification and resolution of problems by communicating and coordinating with the appropriate contacts and by participating in the development and maintenance of internal processes.
Case Coordinator
Cigna Healthspring (Leon Medical Center Health Plans)
01.2005 - 01.2021
- Review patient charts for criteria for admission
- Submit cases not meeting criteria to Medical Director
- Discuss cases meeting & not meeting criteria with Medical Director
- Report via an incident report when a quality-of-care issue has been identified.
Pre-Cert Nurse
Neighborhood Health Partnership, Inc. (NHP)
01.2004 - 05.2005
- Review and process in-coming referrals based on Medicare and Interqual Guidelines
- Submit cases not meeting criteria to Medical Director
- Discuss cases not meeting criteria with Medical Director
- Request additional medical records when information submitted not sufficient.
Senior Quality Coordinator – Quality Management Department
Care Plus Health Plans, Inc.
01.2002 - 01.2004
- Ensured all necessary documentation is completed accurately according to company policies and procedures.
- Reviewed incoming material against purchase orders for conformance with specified requirements prior to acceptance or rejection.
- Investigated non-conforming materials reported by customers or vendors and took appropriate corrective action.
Medical Case Manager and Credentialing Coordinator
Pan American Healthcare (MURA)
01.1999 - 01.2002
- Conducted assessments of patients' physical, mental and social needs.
- Researched information regarding best practices for client care management.
- Assessed ongoing needs of clients and adjusted treatment plans accordingly.
Credentialing Coordinator
CAC United Healthcare, Inc.
02.1998 - 01.1999
- Maintained database of provider information, including contact details and licensure expiration dates.
- Coordinated with departments within the organization to facilitate smooth completion of credentialing process.
Supervisor Medical Review Dept.
CAC United Healthcare, Inc. (AKA CAC-Ramsay)
01.1988 - 12.1997
- Collaborated with other departments to coordinate workflow processes between teams.
- Provided guidance and direction to subordinates regarding job duties and responsibilities.
Supervisor for Utilization Management Department/Overseeing Pre-Cert Dept.
Care Plus Health Plans, Inc.
- Collaborated with multidisciplinary teams including physicians, pharmacists, social workers, case managers, discharge planners and other healthcare personnel regarding utilization management issues.
- Conducted utilization management activities such as pre-certification and pre-authorization requests for services rendered by health care providers.
Medical Case Manager for Pre-Cert Dept.
Care Plus Health Plans, Inc.
- Provided support and resources to patients in need of medical assistance.
- Facilitated communication between patients, families, providers and insurance companies.
Education
Internship in Pediatrics, Internal Medicine, Surgery and Obstetrics & Gynecology
12.1987
Doctor in Medicine -
Universidad Central del Este – San Pedro de Macoris, Dominican Republic
12.1986
Long Beach High School Diploma -
Long Beach High School, Long Beach, New York
12.1978
Skills
- Fluent in English and Spanish with the ability to translate
- Proficient with Electronic Medical Documentation
- Knowledge of Medicare & Medicaid status and regulation
- Culturally competent care
- Decision making ability
- Patient and Family Advocacy authority
- Clear communication skills
- Quality Improvement Competence
- Analytical thinker
- Management Experience
References
Available upon request
Timeline
Community Associate
Blue Cross of Blue Shield Florida
01.2021 - Current
Case Coordinator
Cigna Healthspring (Leon Medical Center Health Plans)
01.2005 - 01.2021
Pre-Cert Nurse
Neighborhood Health Partnership, Inc. (NHP)
01.2004 - 05.2005
Senior Quality Coordinator – Quality Management Department
Care Plus Health Plans, Inc.
01.2002 - 01.2004
Medical Case Manager and Credentialing Coordinator
Pan American Healthcare (MURA)
01.1999 - 01.2002
Credentialing Coordinator
CAC United Healthcare, Inc.
02.1998 - 01.1999
Supervisor Medical Review Dept.
CAC United Healthcare, Inc. (AKA CAC-Ramsay)
01.1988 - 12.1997
Supervisor for Utilization Management Department/Overseeing Pre-Cert Dept.
Care Plus Health Plans, Inc.
Medical Case Manager for Pre-Cert Dept.
Care Plus Health Plans, Inc.
Internship in Pediatrics, Internal Medicine, Surgery and Obstetrics & Gynecology
Doctor in Medicine -
Universidad Central del Este – San Pedro de Macoris, Dominican Republic
Long Beach High School Diploma -
Long Beach High School, Long Beach, New York