Nelida Rivera Cosme
Hemet,CA
Summary
Director of Utilization Management offering case management expertise and ability to quickly build trust and rapport with staff, administration team, unit directors, and other leaders to create a diverse culture. Highly adept at case planning and diagnosis management. Committed to achieving high-quality, cost-effective care for patients and families.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Manager, Utilization Management
Kaiser Permanente
Ontario, CA
09.2022 - Current
- Coordinated audit process by reviewing, analyzing, and reporting findings.
- Planned and facilitated meetings
- Delivered formal presentations to staff
- Collaborated with senior management to deliver timely and valuable outcomes.
- Recruited, hired, and trained employees on operations and performance expectations.
- Managed staff, financials, and key performance indicators to support business operations
- Collaborated with stakeholders to identify and resolve issues
- Coordinated interdisciplinary meetings to reduce length of stay
- Generated reports for data review and corrective actions to meet quality specifications
- Coordinated discharge plans for patients by collaborating with patients, families, placement agencies, and courts.
- Managed a team of 40 employees and oversaw daily operations to enhance productivity
- Maintained composure and professionalism to achieve goals in high-pressure situations and while handling difficult individuals.
- Trained employees at various levels for case management, utilization management, and discharge planning assistant roles to meet corporate goals and ensure compliance.
- Managed staffing levels to optimize productivity and adhere to budget constraints.
- Evaluated business performance at both individual and team levels, identifying areas for improvement.
- Conducted performance evaluations and delivered continuous feedback and coaching to enhance employee performance.
- Provided leadership, insight and mentoring to newly hired employees, sharing knowledge of various company programs.
- Organized team-building activities to enhance camaraderie and promote a positive work environment.
- Planned and delivered training sessions to enhance employee performance and target areas for improvement.
Director, Case Management
Prime Healthcare
Inglewood, CA
07.2022 - 09.2022
- Cultivated and maintained relationships to promote positive work culture.
- Developed and presented new ideas and conceptualized new approaches and solutions.
- Coordinated audit process through review, analysis, and reporting of findings.
- Prepared presentations for board meetings summarizing key developments within the company.
- Delivered formal presentations to staff
- Collaborated with senior management to deliver timely and valuable outcomes.
- Recruited, hired, and trained employees on operations and performance expectations.
- Managed staff, financials, and key performance indicators to support business operations
- Collaborated with stakeholders to identify and resolve issues
- Coordinated interdisciplinary meetings to reduce length of stay
- Generated reports for data review and corrective actions to meet quality specifications
- Coordinated discharge plans for patients by collaborating with patients, families, placement agencies, and courts.
- Managed a team of 50 employees and oversaw daily operations to enhance productivity
- Conducted regular meetings with department heads to review progress on strategic initiatives.
- Reviewed internal reports and identified areas of risk or potential cost savings.
- Maintained composure and professionalism to achieve goals in high-pressure situations and while handling difficult individuals.
- Trained employees at various levels for case management, utilization management, and discharge planning assistant roles to meet corporate goals and ensure compliance.
- Managed staffing levels to optimize productivity and adhere to budget constraints.
- Evaluated business performance at both individual and team levels, identifying areas for improvement.
- Conducted performance evaluations and delivered continuous feedback and coaching to enhance employee performance.
- Provided leadership, insight and mentoring to newly hired employees, sharing knowledge of various company programs.
- Organized team-building activities to enhance camaraderie and promote a positive work environment.
- Planned and delivered training sessions to enhance employee performance and target areas for improvement.
Director, Case Management
Tenet Health
CA and TX
11.2019 - 06.2022
- Conducted regular meetings with department heads to review progress on strategic initiatives.
- Coordinated audit process by reviewing, analyzing, and reporting findings
- Planned and facilitated meetings
- Developed and implemented internal audits to ensure compliance and quality assurance
- Delivered formal presentations to staff
- Interface regularly with senior management to produce timely and valuable results.
- Recruited, hired, and trained employees on operations and performance expectations
- Managed staff, financials, and key performance indicators to facilitate business operations
- Met with stakeholders to address issues and implement solutions
- Coordinated interdisciplinary meetings daily, resulting in reduced length of stay.
- Generated reports to analyze data and implement corrective actions for enhancing quality standards
- Coordinated discharge plans for patients by collaborating with patients, families, placement agencies, and courts.
- Contributed to the development and successful launch of Allscripts and Cerner production
- Directed daily operations and optimized productivity by overseeing a team of 20 employees
- Maintained composure and professionalism while achieving goals in high-pressure situations and when faced with difficult individuals.
- Provided training to employees at different levels for case management, utilization management, and discharge planning assistant positions in order to achieve corporate objectives and maintain compliance.
- Verified consistency, quality, and conformance of completed work with federal and state regulations.
- Ensured optimal staffing levels to maximize productivity and adhere to budget constraints.
- Evaluated employee performance based on predetermined benchmarks.
Case Manager, Travel
American Mobile Healthcare
San Diego, CA
07.2016 - 11.2019
- Conducted patient assessments and evaluations for discharge planning, coordinating services for individuals in need of home care, home infusion, and durable medical equipment (DME).
- Provided training to fellow nurses on patient care and daily tasks, fostering their growth and professional development
- Developed patient care plans, conducted overall patient health assessments, and performed evaluations.
- Collaborated with physicians during medical rounds, updated treatment plans, and provided a plan of care to patients and families
- Identified insurance coverage, communicated care preferences to practitioners, and verified interventions met patients' treatment goals.
- Obtained recommendations for level of care by consulting with a physician advisor
- Determined and coordinated optimal care levels to address individual patient requirements.
- Arranged admissions and transfers based on clinical standards and guidelines.
Education
Bachelor of Science in Nursing Science -
Aspen University
04.2022
Associate of Science in Nursing Science -
Herzing University
08.2011
Skills
- Critical Thinking
- Legal and Regulatory Compliance
- Issues Resolution
- Attention to Detail
- Quality Assurance
- Staff Management
- Operations Management
- Staff Development
- Complex Problem-Solving
- Performance Evaluations
Certification
- Registered Nurse CA 95111823
- BLS expires 6/2026
Languages
Spanish
Native/ Bilingual
Accomplishments
Team Excellence Award Enhanced Care at Home
The Team Excellence Award recognizes our Enhanced Care at Home (ECAH) initiative, aimed at offering an alternative to skilled nursing facility (SNF) care for eligible patients. By providing care in the comfort of patients' homes, we mitigate SNF-related risks and enable higher acuity patients to access SNF care. With an estimated $5.4 million saved from SNF diversion, our program also reduces SNF discharge rates, allowing lower acuity patients to receive rehabilitation at home and freeing up SNF bed capacity for those with greater needs. Originating in SBC, this program marks a significant advancement in patient-centered care.
Team Excellence Award Extended Length of Stay
The Team Excellence Award recognizes our commendable efforts in decreasing our extended length of stay (ELOS). This was achieved through the implementation of daily follow-ups on action items identified during CWD rounds and weekly ELOS meetings. Real-time escalations were introduced, with case managers instructed to promptly escalate any issues as they arise. Collaborating closely with the interdisciplinary team yielded significant results, evidenced by a notable reduction in average length of stay (ALOS) from May 2023 to July 2023. This achievement translates to an estimated savings of $8.3 million for SBC.
References
References available upon request.
Timeline
Manager, Utilization Management
Kaiser Permanente
09.2022 - Current
Director, Case Management
Prime Healthcare
07.2022 - 09.2022
Director, Case Management
Tenet Health
11.2019 - 06.2022
Case Manager, Travel
American Mobile Healthcare
07.2016 - 11.2019
Bachelor of Science in Nursing Science -
Aspen University
Associate of Science in Nursing Science -
Herzing University
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