Molly Sanzar, RN BSN, CCM
Irvine,CA
Summary
Seasoned nursing professional with 15 years of experience in hospital, assisted living, the state, and managed care. Offering proven clinical knowledge, natural interpersonal strengths, and technical abilities, an interdisciplinary collaboration focused on optimizing patient care and support, and a quality-focused and efficiency-driven leadership.
Overview
16
16
years of professional experience
1
1
Certification
Work History
RN Complex Case Manager
Landmark Healthcare/ OptumCare
03.2020 - Current
- Manage 8-12 complex case-patients per day with care coordination, disease management
- Act as liaison between patients and providers, nursing facilities, hospitals, and program staff for patients' health care needs (meds, DME, home health, hospitalizations)
- Triage patients for urgent care or emergency referrals and escalate to appropriate healthcare providers
- Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected them to optimal providers and care.
RN Complex Case Manager II
HealthNet Of California/ Centene
08.2017 - 03.2020
- Documented using EMR TruCare system, CVS Caremark, and Ubiquity for patient care
- Participated in team projects, demonstrating ability to work collaboratively and effectively
- Participated and attended interdisciplinary team meetings using SBAR report format
- Created individualized care plans based on nursing diagnosis and incorporated appropriate nursing methods to achieve positive outcomes.
RN Quality Coordinator Nurse II
Health Net, Inc. Of California
07.2016 - 08.2017
- Conduct quality projects- PDSAs with patient study groups by collaborating with the California Department of Health Care Services (DHCS) and local clinics to improve the quality of care for Medi-Cal members
- Participated in the accreditation of NCQA for health plan
- Conducted primary physician offices audits and certified/renew certification on behalf of DHCS-Medi-Cal
- Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected them to optimal providers and care.
RN Nurse Evaluator II
Department Of Health Care Services
01.2015 - 07.2016
- Case management and care review based on Medi-Cal regulations and coordination of benefits with managed care or other private insurance.
- Lead and conducted focused and/or Retrospective Reviews for outpatient- County mental health facilities and inpatient-state hospitals to measure and evaluate the quality of care, and coordination of services using cost-effective services provided patients by the State and Federal Regulations (CMS) and California Code of Regulations (CCR)
- Provided consultations, training, or technical support to the counties regarding compliance with Federal and State Regulations of Medi-CAL
- Assisted in creating policies and supporting them with research and clinical experience and knowledge.
- Prepared plan of corrections and Findings reports post reviews.
- Processed Treatment Authorization Requests for acute and administrative hospital days to approve or deny based on CMS regulations.
Regional Director of Quality and Risk Management
Emeritus Senior Living
05.2013 - 12.2014
- Assessed and evaluated patients for level of care and acuity for placement in Assisted living and ensure correct patients staffing ratios
- Multi-site management and Evaluation of twelve (12) Communities on Quality Service and Risk and Liability
- Conducted annual comprehensive Peer Review surveys to measure and evaluate Quality Service for care communities and assisted the communities with a plan of correction and follow-up visits
- Educated on and Implemented Infection Control policies and procedures in Facilities
- Promoted positive motivation, identify problems and/or deficiencies, assist in developing action plans, educating staff, and implementing solutions to operational issues
- Provided training/education and support at Corporate, Regional, and Community levels to staff
- Utilized systems to minimize company risk exposure but not limited to risk reporting systems, resident risk highlights, resident evaluation systems, pharmacy systems, etc.
- Conducted Investigation of Patients/Family/State matters- Collected Data and analyzed
Resident Care Director
Emeritus Senior Living
02.2011 - 04.2013
- Hired, supervised, and trained LPN, Medication Techs, CNAs, and other staff,
- Managed Residents/Patients with various illnesses –DM, CHF, Renal, COPD, etc.
- Audited charts and ensured staff complied with the State and Federal Laws and Emeritus Policies
- Maintained high occupancy- increased by 20% Resident admissions.
- Assessed and Documented using EMR
Charge Nurse
Prince William Hospital
09.2009 - 07.2011
- Coordinated nursing care on the unit through staff assignments, assisting and rounding with physicians, monitoring patient orders, and communicating with ancillary departments.
- Supervised and managed daily scheduling, tasking, and administration.
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Monitored nursing care, patient assessment processes, and treatment implementations.
Registered Nurse, Medical-Surgical Unit
Inova Fairfax Hospital
07.2007 - 09.2009
- Provided direct patient care, stabilized patients and determined the next course of action.
- Minimized hospital stays with recovery-centered approaches, reducing average in-patient stay length.
- Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use, and disease management.
- Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.
Education
Bachelor of Science - Nursing
The University of Texas At Arlington
Arlington, TX05.2023
Associate of Applied Science - RN Nursing
Northern Virginia Community College, Middlesex County College
Springfield, VA05.2007
Skills
- Provide Quality and cost-effective patient care
- Excellent people skills with good organizational and problem-solving abilities
- Hardworking, flexible, and goal-oriented in meeting company's goals/metrics/agendas
- Computer proficient (word, excel, PowerPoint, EMR)
Accomplishments
- Participated in the accreditation of health plan with NCQA
- Achieved quarterly QIP marks for patients discharge and urgent episodes of follow-up care.
- Patient Advocacy - Explained treatment procedures, medication risks, special diets and physician instructions to patients.
Certification
Certified Case Manager (CCM), expires 12/2023; American Heart Association BLS/CPR Certified, expires 12/2023; RN Nursing License, expires 03/31/2025
Affiliations
- American Nurses Association (ANA) Member
- Case Management Society of America
Timeline
RN Complex Case Manager
Landmark Healthcare/ OptumCare
03.2020 - Current
RN Complex Case Manager II
HealthNet Of California/ Centene
08.2017 - 03.2020
RN Quality Coordinator Nurse II
Health Net, Inc. Of California
07.2016 - 08.2017
RN Nurse Evaluator II
Department Of Health Care Services
01.2015 - 07.2016
Regional Director of Quality and Risk Management
Emeritus Senior Living
05.2013 - 12.2014
Resident Care Director
Emeritus Senior Living
02.2011 - 04.2013
Charge Nurse
Prince William Hospital
09.2009 - 07.2011
Registered Nurse, Medical-Surgical Unit
Inova Fairfax Hospital
07.2007 - 09.2009
Bachelor of Science - Nursing
The University of Texas At Arlington
Associate of Applied Science - RN Nursing
Northern Virginia Community College, Middlesex County College
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