Nitika Dumathia
Rancho Cucamonga,CA
Summary
Skilled professional with strong Clinical background, ready to excel in leadership role. Process and detail oriented, passionate about quality and continuous improvement; string project management skills. Ability to thrive in a highly collaborative and team oriented environment along with working independently. Proficiency in MS Office Software including Word, Excel, and Power Point. Knowledge and abilities in the principles and practices of organizational development, change management and process improvement methodologies.
Overview
14
14
years of professional experience
Work History
Utilization Review Supervisor/ Care Management
Prime Healthcare Services
01.2024 - Current
- Overseeing workflows and processes as well as continuously looking for improvements in the current Utilization Review and Case Management workflow.
- Providing training, supervision, and mentoring of subordinates/ teammates/ Case Management Directors & staff or all Prime Facilities
- Working independently while being a liaison with other teams and outside organizations to improve the work processes and quality
- Assigning and monitoring works flows in coordination with special projects, prioritizing and adjusting activities in alignment with company goals and objectives on a routine or ad hoc basis
- Providing recommendations for process improvements; implementing and communicating policy and procedural changes as they affect the assigned function(s)
- Collaborating with direct management on an ongoing basis to ensure the effective establishment of goals, objectives, and priorities within the assigned function(s)
- Serving as a liaison to cross-divisional teams; facilitating open communication and coordination of related goals, objectives, and priorities with a focus on company-wide consistency and continuous improvement
- Providing high-level management of the assigned team(s) through ongoing leadership and guidance; collaborating with Human Resources on employee matters
- Researching trends reported by support team members that may be specific to a payer, service, or provider, and outline the details up to resolution
Medical Review Coordinator/ Project Management
Prime Healthcare Services
03.2021 - 12.2023
- Currently working on Case Management Projects for 46 Prime Healthcare facilities
- Length of stay Projects: Anticipated vs Actual Discharge & LOS vs GMLOS for Medicare accounts
- CMS Compliance Project for Case Management- Discharge Planning, MOON Notice, IM Message & Patient Choice: Quarterly Audits for all Facilities to ensure CMS guidelines are being followed
- Process Improvement- For existing projects to ensure goals are achieved timely
- Assisting in Data Quality and Compliance reports
- Designing, producing and/ or updating any new or existing materials needed to educate staff
- Monitoring authorization process for traditional Medicaid and commercial payors
- Monitoring Authorization process for commercial payors and assisting in improving data quality of compliance reports
Infection Control Preventionist
Saint Francis Medical Center
08.2020 - 06.2021
- Company Overview: Prime Healthcare
- Monitor and report incidents of infectious diseases to local and state health agencies
- Plan and direct studies to investigate human or animal disease, preventive methods, and treatments for disease
- Communicate research findings on various types of diseases to health practitioners, policy makers, and the public
- Provide expertise in the design, management and evaluation of study protocols and health status questionnaires, sample selection and analysis
- Oversee public health programs, including statistical analysis, health care planning, surveillance systems, and public health improvement
- Investigate diseases or parasites to determine cause and risk factors, progress, life cycle, or mode of transmission
- Educate healthcare workers, patients, and the public about infectious and communicable diseases, including disease transmission and prevention
- Conduct research to develop methodologies, instrumentation, and procedures for medical application, analyzing data and presenting findings
- Identify and analyze public health issues related to foodborne parasitic diseases and their impact on public policies or scientific studies or surveys
- Supervise professional, technical and clerical personnel
- Plan, administer and evaluate health safety standards and programs to improve public health, conferring with health department, industry personnel, physicians and others
- Consult with and advise physicians, educators, researchers, government health officials and others regarding medical applications of sciences, such as physics, biology, and chemistry
- Standardize drug dosages, methods of immunization, and procedures for manufacture of drugs and medicinal compounds
- Prime Healthcare
Infection Control Preventionist
Prime Healthcare Services
10.2019 - 08.2020
- Worked at corporate level and different Prime facilities in LA county and Orange County
- The various duties while in the facility:
- Performing analysis of surveillance data to identify trends in rates, pathogens, and antimicrobial resistance
- Interacting with physicians, committees, and healthcare workers and recommends and participates in activities to control and/or prevent infectious outcomes and healthcare associate infections using continuous quality improvement methodology to improve organizational performance across the continuum (inpatient and ambulatory)
- Performing ongoing infection prevention surveillance activities as directed by the facility's Infection Control Committee
- This includes data analysis and development of strategies for improving healthcare outcomes
- Compilation and entering mandated surveillance elements in NHSN via the secure data network (SDN)
- Maintaining a knowledge base of current infection prevention information through continuing education, published literature, internet access and professional organizations
- Implementing prevention strategies including educating/consulting for staff, physicians and hospital departments
- Assisting in the analysis of surveillance data to identify trends in rates, pathogens, and antimicrobial resistance
Infection Control Trainee
Glendora Community Hospital
10.2018 - 10.2019
- Company Overview: Prime Healthcare
- Worked under direct supervision of the CNO and PI director performed the following duties:
- Implementation of new policies leading to a 50% reduction in hospital acquired infections within first three months
- Surveillance and data reporting to NHSN Created application to abstract data and continually monitor and evaluate data related to hospital acquired infections
- Educate key health system leadership and healthcare professionals on methods to decrease infections
- Consult with senior management and department directors on strategies for compliance with Joint Commission, DPH, CMS, and OSHA safety regulations and requirements
- Spearhead development of innovative initiatives for the proactive prevention of hospital acquired infections
- Identified need for lab testing of infections and implemented testing program
- Prime Healthcare
Volunteer
Glendora Community Hospital
10.2017 - 08.2018
- Company Overview: Prime Healthcare
- Prime Healthcare
Medical Intern
Government Medical College
05.2011 - 06.2012
- Company Overview: Amritsar, Punjab
- 10 Months of internship from Government Medical College, Amritsar, Punjab, India
- Clinical Rotations with hands -on experience in the departments of Internal Medicine, General Surgery, Obstetrics and Gynecology, Pediatrics, Neonatology, Emergency Medicine, Anesthesiology, Orthopedics, ENT, Psychiatry, Ophthalmology
- Responsibilities handled as an intern: Assisting the senior physicians in examining patients
- Diagnosing the disease as per the symptoms
- Learning diagnostic methods and equipment
- In case of emergency, giving basic treatment to the patients
- Helping other medical staff in performing their duties
- Amritsar, Punjab
Medical Intern
Vydehi Institute of Medical Sciences and Research Center
03.2011 - 05.2011
- Worked in a community healthcare center as a medical intern
- Worked in an underserved area with shortage of physicians
- Performed all the following duties under the supervision of a primary care physician: Doing physical examination of patients
- Diagnosis of the Outpatient Cases
- Prescription of the drugs depending on the symptoms
- Referring patients to the nearest hospital if require immediate medical attention
- Educating people to make better lifestyle changes to lead a healthy life
Education
Master of Health Administration - Leadership
UNIVERSITY OF LA VERNE
La Verne, CA08.2018
M.B.B.S - Medica & Surgery
VYDEHI INSTITUTE OF HEALTH SCIENCES AND RESEARCH CENTER
Bangalore, Karnataka08.2008
High School Diploma -
DAV PUBLIC SCHOOL
Pathankot, Punjab01.2002
High School Diploma -
ST. JOSEPH'S CONVENT SCHOOL
Pathankot, Punjab01-2000
Skills
- Project management
- Verbal and written communication
- Strong clinical skills
- Adaptability and flexibility
- Quality control
- Training and mentoring
- Goal oriented
- Staff management
- Process monitoring and improvement
- Audit reporting
- Policy and procedure development
- Operations management
Languages
English
Hindi
Urdu
Punjabi
Timeline
Utilization Review Supervisor/ Care Management
Prime Healthcare Services
01.2024 - Current
Medical Review Coordinator/ Project Management
Prime Healthcare Services
03.2021 - 12.2023
Infection Control Preventionist
Saint Francis Medical Center
08.2020 - 06.2021
Infection Control Preventionist
Prime Healthcare Services
10.2019 - 08.2020
Infection Control Trainee
Glendora Community Hospital
10.2018 - 10.2019
Volunteer
Glendora Community Hospital
10.2017 - 08.2018
Medical Intern
Government Medical College
05.2011 - 06.2012
Medical Intern
Vydehi Institute of Medical Sciences and Research Center
03.2011 - 05.2011
M.B.B.S - Medica & Surgery
VYDEHI INSTITUTE OF HEALTH SCIENCES AND RESEARCH CENTER
High School Diploma -
DAV PUBLIC SCHOOL
Master of Health Administration - Leadership
UNIVERSITY OF LA VERNE
High School Diploma -
ST. JOSEPH'S CONVENT SCHOOL
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