NINA MORALES LOPEZ

• Managed caseload to satisfy multiple members with diverse needs & Lines of Business (LOB).
• Managed other teams case loads over 30+ while maintaining compliance
• Provided members, facility staff and family education on available resources and self-care strategies.
• Collaborated with healthcare providers to drive quality/compliance of care.
• Coordinated individualized discharge plans to manage safe transition back into Nursing Home Care.
• Conducted Nursing Home Face-to-Face visits to provide supportive services with member needs.
• Assisted patients in accessing housing, financial assistance and other community resources as needed.

Develop and implement programs and initiatives to improve and monitor service delivery and outcomes for assigned populations.
•Develop, implement and monitor project plans to meet goals and timelines
•Facilitate program data collecting and reporting; analyze data and measure outcomes; develop and modify programs as needed
•Request corrective action plans from providers that are non-compliant and/or fail to meet contract requirements
•Develop training modules and train appropriate users
•Lead cross-departmental teams in the implementation of program development and quality improvement effort
•Track access to care, treatment services, and outcomes for specific populations

• Established goals and created action plans to achieve goals.
• Maintained regular communication between departments via email and phone calls to coordinate program logistics.

Vendor Oversight for In Home Medical Group. Keeping an open communication with the vendor and the health plan to assure compliance for our members. Daily IP/DC reports, CM-Detail reports, reports requesting HRAs. Continue to train new staff/refresher trainings.
· Work with community outreach/member advocates such as nursing homes, Illinois Dept. of Aging, Illinois Dept. of Rehab Services, and supportive living facilities to coordinate members care.
· Educate physicians, hospital staff, members and community resources on program
specifications and available support services.
· Conduct on-site nursing home visits with members to evaluate current or future health care
needs and discuss progress with clinical staff.
· Develop and modify care plans in conjunction with member, members family, and managing
physician.
· Communicate telephonically with members to assess their health care needs.

• Scheduled and supervised staff meetings to discuss new ideas and update participants on program details and milestones.
• Created and delivered program training and education to keep participants knowledgeable about program and provide necessary skills to participate productively.
• Developed and maintained relationships with external partners to facilitate program operations.