Summary
Overview
Work History
Education
Skills
Communication Skills
Personal Information
Timeline
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MERYEM BOUROUIS OGGAD

NORTH MIAMI,FL

Summary

Compassionate and highly motivated RN with over 27 years of case management experience coordinating care for diverse patient population at home, skilled nursing facilities/rehab centers, and assisted living facilities. Skilled in developing personalized care plans, collaborating with interdisciplinary teams and ensuring compliance with healthcare regulations. Great Team player.

Overview

25
25
years of professional experience

Work History

Health Social Services Manager

United Healthcare
11.2013 - Current
  • Supervise a team of 15-21 healthcare professionals comprised of Social Workers, Registered Nurses, and Licensed Practical Nurses
  • Perform UM reviews of inpatient and outpatient services
  • Determine medical appropriateness of services following evaluation of medical guidelines and benefit determination
  • Recruit and onboard new team members
  • Manage the team members’ day-to-day activities, to guide all team members to achieve or exceed production and quality metrics
  • Coach and create performance improvement plans for team members who fail to meet established metrics
  • Assist with various project management, quality, and operations team to improve program performance
  • Investigate and submit critical Incident reports through the state’s portal
  • Respond to Agency for Healthcare Administration Medicaid complaints
  • Conduct internal and external audits of clinical charts (state, federal and NCQA/HEDIS)
  • Collaborate cross functionally with departments and case management team to address business and operational challenges
  • Communicate organizational priorities and vision to team members.

Care Manager

United Healthcare
07.2005 - 11.2013
  • Coordinated enrollee care needs for assigned members who are primarily medically complex and require intensive medical and psychosocial support
  • Visited home and community-based members and members residing in long term care/rehab facilities
  • Assessed care needs for clients subscribed to Medicare/Medicaid benefits through the application of clinical knowledge and risk management factors
  • Worked to reduce the risk of ER and inpatient admissions
  • Assured the provision of appropriate services in acute, home, chronic and alternative settings.

Director of Social Services

Royal Health Care Center – Santa Ana, Ca
08.2003 - 03.2004
  • Oversaw the overall operation of the social service department
  • Head of the Behavioral Management committee, completed assessments of residents to assure that they are receiving the appropriate treatment
  • Coordinated family conferences to discuss residents' plan of care
  • Responsible for discharge planning
  • Maintained open communication and made referrals to outside agencies
  • Provided training to staff on residents' rights and on the facility's policies and procedures.

Director of Social Services

King James Health Care Center – Chatham, NJ
01.2001 - 01.2003
  • Provided direct services to all residents in the form of advocacy, and referral service
  • Aided in the adjustment of newly admitted residents and their families
  • Documented the social history and progress notes of each resident, including completing MDSs according to standards developed by regulatory agencies
  • Actively participated in regularly scheduled staff meetings, including the Interdisciplinary Care Plan team in the development of the care plan for each resident
  • Conducted in-service programs to educate staff on residents' rights and abuse
  • Responsible for coordinating the provision of community resources.

Director of Social Services

Manor Health Care Services – Mountainside, NJ
01.2000 - 01.2001
  • Planned, organized, developed, and directed the overall operation of the Social Services Department
  • Coordinated and implemented social services and psycho-social needs for residents and their families
  • Responsible for the interface with the family including the admission, transfer, and discharge process of residents in the sub-acute unit
  • Conducted meetings with the psychiatrist, rehab, and nursing departments
  • Assisted with the development of clinical pathways and protocols
  • Scheduled family conferences to discuss residents' progress and discharge.

Education

Associate of Science - Nursing

Miami Dade College
Miami
02.2024

Master of Science - Human Resources

Nova Southeastern University
Davie
01.2014

Bachelor’s Degree in Social work -

Rutgers University
Newark
01.1997

Skills

  • Proficient in Microsoft Office Suites (Word, Excel, Power Point, Teams, Outlook and SharePoint
  • Time Management
  • Attention to Detail
  • Problem-solving abilities
  • Multitasking
  • Assessment skills
  • Client Advocacy
  • Multicultural Sensitivity
  • Service Integration
  • Relationship cultivation
  • BLS Certified

Communication Skills

French, Arabic, Conversational Spanish, Excellent communication skills. Strength in working under pressure, strict deadlines in changing environment. Great team player.

Personal Information

Title: RN in the State of Florida, Multistate/Compact RN license, MSHRM, BSW

Timeline

Health Social Services Manager

United Healthcare
11.2013 - Current

Care Manager

United Healthcare
07.2005 - 11.2013

Director of Social Services

Royal Health Care Center – Santa Ana, Ca
08.2003 - 03.2004

Director of Social Services

King James Health Care Center – Chatham, NJ
01.2001 - 01.2003

Director of Social Services

Manor Health Care Services – Mountainside, NJ
01.2000 - 01.2001

Associate of Science - Nursing

Miami Dade College

Master of Science - Human Resources

Nova Southeastern University

Bachelor’s Degree in Social work -

Rutgers University

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MERYEM BOUROUIS OGGAD