Marivel Roque
San Antonio,USA
Summary
Compassionate and knowledgeable LVN/LPN with a proven track record in delivering exceptional patient care and wellness support. Expertise in patient assessment and care plan development consistently contributes to improved patient outcomes and overall well-being. Strong communication and critical thinking skills effectively foster collaborative relationships with patients and interdisciplinary teams across diverse healthcare environments. Committed to upholding the highest standards of care while adapting to the dynamic needs of patients.
Overview
11
11
years of professional experience
Work History
Community Wellness Nurse
WellMed
06.2022 - Current
- Support Disease Management and Chronic Care Program requirements for medical group/health plan members
- Act as an educator, resource and advocate for members and their families to ensure a maximum level of independence
- Conduct visits and review the patient’s informal and formal support systems, focusing on what patients want to improve and educating them about their chronic disease
- Improved patient well-being by conducting comprehensive health assessments and developing personalized care plans.
- Discussed such topics as proper nutrition and lifestyle changes to help patients live healthier lives.
- Collaborated with interdisciplinary teams to develop and implement holistic care plans for diverse patient populations.
Virtual Therapy Specialist
3M
02.2022 - 06.2022
- Educating patients on the importance of using therapies in accordance with provider recommendations
- Utilize one’s understanding of 3M technology to problem solve and trouble shoot abnormalities and decide upon the appropriate course of action
- Determining when to escalate issues to patient care givers to support overall adherence and appropriate use of prescribed therapies
- Supporting patients telephonically to understand challenges with use of 3M therapies in the home care setting and troubleshooting issues
Service Coordinator I – full time
Centene Corporation
09.2019 - 02.2022
- Work with community outreach/member advocates to coordinate member care.
- Complete medical necessity and level of care reviews for requested services using clinical judgement and refer to Medical Directors for review depending on case findings.
- Managed a high volume of client requests, ensuring timely and effective service delivery.
- Assessed member needs and developed solutions to meet needs through the completion of health screens and other resources.
Case Manager I MEDICAID (Prior Authorization)
Centene Corporation
09.2014 - 03.2018
- Reviewed prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage.
- Performed medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria
- Worked with healthcare providers and authorization team to ensure timely review of services
- Coordinated with healthcare providers and interdepartmental teams, to assess medical necessity of care of member
- Escalated prior authorization requests to Medical Directors as appropriate to determine appropriateness of care
- Collected, documented, and maintained all member’s clinical information in health management systems to ensure compliance with regulatory guidelines
- Provided feedback on opportunities to improve the authorization review process for members
- Ensured compliance with all policies and standards
- Demonstrated clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred.
- Worked with both Medicare and Medicaid with knowledge of utilization management processes.
- Case Manager I MEDICARE (Prior Authorization, Appeals/Denials) 05/2013-09/2014
- Program Specialist (11/2012-05/2013)
Education
LVN program -
St. Philips College
San Antonio, TX01.2006
Skills
- Proficient in Microsoft Word, Excel, Kinnser software, Amisys, CCMS, CRM, TruCare
- Care plan development
- Diabetes education
- Health education
- Chronic disease management
- Teamwork and collaboration
- Compassionate and caring
- Multitasking Abilities
Languages
English
Native or Bilingual
Spanish
Professional Working
Timeline
Community Wellness Nurse
WellMed
06.2022 - Current
Virtual Therapy Specialist
3M
02.2022 - 06.2022
Service Coordinator I – full time
Centene Corporation
09.2019 - 02.2022
Case Manager I MEDICAID (Prior Authorization)
Centene Corporation
09.2014 - 03.2018
LVN program -
St. Philips College
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