Michelle Villanueva

• Developed and implemented comprehensive case management plans to address client needs and goals.
• Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
• Monitored clients' progress and tracked client services to provide crisis interventions.

• Reviews and evaluates proposed services utilizing medical criteria and/or establish policies and procedures.
• Determines the appropriate action for the service being requested for approval, modification or denial, and refers to the medical director for review when necessary.
• Identifies diagnosis and determines need for continuing hospitalizations; monitors the inpatient length of stay as per established guidelines and professional judgement.

• Under the direct supervision of a Registered Nurse or physician provides nursing care in accordance with the legal scope of practice and within established standards of care, policies and procedures. Demonstrates performance consistent with the Mission, Vision and Strategic Plan of the organization. Demonstrates quality and effectiveness in work habits and clinical practice and treats coworkers, patients, families and all members of the health care team with dignity and respect.
• Upholds Kaiser Permanente's Policies & Procedures, Principles of Responsibilities & applicable state, federal & local laws.
• Performs patient care functions, within the scope of competency, considering age related needs of the patient as prescribed by physician/health care professional's) following established protocols, policies and procedures.
• Prepare & administer medications as directed by physician order following established protocols.
• Monitor patient flow & assign/direct other ancillary personnel as needed.
• Provide medical information & education to patients, following established protocols & guidelines.
• Document pertinent patient information, assessment & nursing procedures following established protocols.
• Maintain patient confidentiality.
• Review, explain & clarify physician orders with patient.
• Instruct patient in use of home equipment.
• Monitor patient vital signs.
• Prepare patients for physical examinations.
• Maintain clean work area.
• Answer member inquires.
• Observe patient condition for reactions during & after procedures.
• Take & record patient vital signs, height, weight, etc.
• Obtain specimens from patients (urine, stool, etc.).
• Perform finger sticks to obtain blood samples.
• Prepare specimens & specimens for lab analysis.

• Under general supervision, provides day-to-day staff, logistical and administrative assistance to the HCII clinic. Schedules appointments; screens and refers phone calls; communicates and interacts with patients; provides clerical and staff support to the department and assist with clerical operations as required and permitted.
• Schedules diagnostic test ordered by the physician as needed. Performs various administrative duties, including answering phones patient calls, returning calls, receiving and sorting in coming faxes. Ensures patients right to privacy, safety and confidentiality is maintained. Maintains a safe environment in accordance with standards, policies, and safety regulations.

Medical Authorization Assisting CCR:

• Receive inpatient requests via fax, phone or electronically
• Obtaining medical records for inpatient case manager
• Documenting all case information in the system Date entry into appropriate database for monitoring and tracking
• Following up on phone as directed by case manager
• Processing intake clinicals received from facilities
• Assisting with authorization functions and gathering information for case manager
• Provide effective, efficient and courteous interaction with facilities, providers, members and their family along with other staff
• Create inpatient events based on facesheet and/ or clinical received
• Verification of member eligibility Collect additional clinicals from providers/ facilities to complete prospective, concurrent or retrospective inpatient services review
• Assist inpatient case manager in gathering clinicals, obtaining appropriate coding for diagnosis and procedures, discharges dates, dispositions, and conducts follow up phone calls.
• Document all contacts and case information in the system using the standard charting format.

NOA: Notice of Action Letter Assistant

• Assisting Denial case managers with Spanish translation letters, faxing letters to appropriate providers office and member, confirming contact information, documenting .
• Assisting Outpatient department with referrals request, verifying members coverage, preparing referrals to forward to nurse with attention to detail.

• Established and maintained working relationships with agencies for members discharge needs.
• Making every contact with case manager informative, productive and positive to complete care for our members and give proper documentation to providers.
• Educating members about programs, benefits and services.
• Managing intake of members admission/discharge information.
• Working with hospital, clinics, facilities and clinical team to manage request for services to members.
• Manage referral process by Processing incoming and outgoing referrals and prior authorizations.
• Receive care coordination cases from clinical assessment to send to case manager.
• Provide appropriate facilities authorizations for discharge planning.
• Coordinate in network hospital transfers, assisting clinical staff with setting up proper documents.
• Verifying benefits and eligibility for members, verifying contracting providers and facilities.
• Verifying appropriate ICD-9/ICD 10 and CPT coding usage.
• Communicate and coordinate admission notifications to case manager.
• Coordinate with case manager and members for discharge orders to ensure that services promote quality and cost-effective outcomes.
• Review clinicals received for proper documentation to create authorizations for members hospital stay.
• Submit and include all documentation received to proper case manager.
• Initiate contacts with patient, family and other clinicals staff as needed to obtain additional information to provide to case manager/ and or for discharge planning.
• Make appropriate adjustments with clinicals staff for discharge orders to promote better outcomes in members care.