Olga Hinojosa
Brownsville,Texas
Summary
Experienced professional seeking a managerial role, dedicated to utilizing existing knowledge and people leadership skills to provide effective guidance and support.
Overview
18
18
years of professional experience
Work History
Health Service Manager
United Healthcare StarKids
02.2022 - Current
- Managed a team of LTSS service coordinators, ensuring compliance with contractual requirements and Medicaid regulations.
- Provided feedback and input for RFP and state deliverables as needed.
- Monitored work assignments and caseloads of long-term care management staff based on state requirements, care management staff experience, and member needs.
- Evaluated staff performance regularly, providing constructive feedback for professional growth opportunities.
- Reviewed and monitored member EMR data to identify trends and improve quality of care in accordance with state and federal regulations, while participating in internal audits.
- Created and implemented standard operating procedures, templates, job aides and processes to improve efficiency.
- Collaborated closely with other healthcare managers across the organization on special projects and state deliverables.
- Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
- Developed and updated policies and procedures, maintaining compliance with guidelines relating to HHSC.
Health Service Manager
United Healthcare StarKids
02.2022 - Current
- Managed a team of LTSS service coordinators, ensuring compliance with contractual requirements and Medicaid regulations.
- Provided feedback and input for RFP and state deliverables as needed.
- Monitored work assignments and caseloads of long-term care management staff based on state requirements, care management staff experience, and member needs
- Evaluated staff performance regularly, providing constructive feedback for professional growth opportunities.
- Reviewed and monitored member EMR data to identify trends and improve quality of care in accordance with state and federal regulations, while participating in internal audits.
- Created and implemented standard operating procedures, templates, job aides and processes to improve efficiency.
- Collaborated closely with other healthcare managers across the organization on special projects and state deliverables.
- Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
- Developed and updated policies and procedures, maintaining compliance with guidelines relating to HHSC.
StarKids Appeals RN
United Healthcare StarKids
02.2020 - 02.2022
- Performed timely internal appeals for all StarKids LTSS services.
- Performed detailed review of state medicaid regulations, handbooks, TAC, and managed care contract.
- Reviewed electronic medical records and verified if the requested service met criteria and state guidelines.
- Participated in State Fair Hearings to defend adverse benefit determinations.
- Created notice of adverse determination letters adhering to NCQA requirements.
- Created processes and templates for use with all LTSS StarKids appeals and fair hearing decisions.
- Trained and mentored staff on job duties for appeal reviews and fair hearings.
- Identified trends and reported findings to leadership.
- Worked with leadership to deliver staff trainings and corrective actions for identified deficiencies.
RN Service Coordinator
United Healthcare StarKids
05.2016 - 02.2020
- Performed comprehensive assessments for all members on caseload based on state requirements.
- Assessed, planned and implemented care strategies directed towards the most appropriate, and least restrictive level of care for special needs children.
- Provided assistance and community referrals to individuals with mental health and/or substance abuse disorders.
- Identified and initiated referrals for social service programs, including financial, psychosocial, community and state supportive services
- Managed the care plan throughout the continuum of care as a single point of contact Communicate to ensure quality coordinated care and services provided expeditiously to all members
- Advocated for patients and families as needed to ensure the patient’s needs and choices were fully represented and supported by the health care team.
- Identified gaps in care and SDOH (social determinants of health) for escalation to ensure members needs were met.
RN Field Nurse
Superior Home Health
05.2009 - 05.2016
- Assessed patient conditions in the home by completing a thorough assessment to develop a plan of care.
- Provided intermittent skilled nursing are in the home.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment
- Educated patients, families and caregivers on diagnosis, disease process, and treatments.
- Supervised LVNs, HHAs, and other nursing staff to ensure standards of care, standard precautions, and compliance with regulations.
ADON, RN Case Manager
Lower Valley Home Health
07.2012 - 12.2012
- Assessed patient conditions in the home by completing a thorough assessment to develop a plan of care.
- Provided intermittent skilled nursing are in the home.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment
- Educated patients, families and caregivers on diagnosis, disease process, and treatments.
- Supervised LVNs, HHAs, and other nursing staff to ensure standards of care, standard precautions, and compliance with regulations.
RN Field Nurse
Superior Home Health
11.2009 - 02.2012
- Assessed patient conditions in the home by completing a thorough assessment to develop a plan of care.
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Managed care from admission to discharge.
- Monitored patient reactions to drugs and carefully documented findings.
- Provided direct patient care, stabilized patients, and determined next course of action.
- Wound care certified. Trained staff on proper wound care and wound vac use.
RN/Case Manager
Rio Home Care
08.2009 - 11.2009
- Assessed patient conditions in the home by completing a thorough assessment to develop a plan of care.
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Managed care from admission to discharge.
- Monitored patient reactions to drugs and carefully documented findings.
- Provided direct patient care, stabilized patients, and determined next course of action.
- Wound care certified. Trained staff on proper wound care and wound vac use.
RN/Case Manager
Halo Home Health
06.2009 - 08.2009
- Assessed patient conditions in the home by completing a thorough assessment to develop a plan of care.
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Managed care from admission to discharge.
- Monitored patient reactions to drugs and carefully documented findings.
- Provided direct patient care, stabilized patients, and determined next course of action.
- Wound care certified. Trained staff on proper wound care and wound vac use.
LVN Field Nurse/QA
Halo Home Health
04.2008 - 06.2009
- Monitored vital signs and assessed patients regularly, swiftly identifying any changes in condition and addressing concerns promptly.
- Administered medications accurately and in a timely manner, ensuring proper treatment for various conditions.
- Documented accurate and complete patient information to address patient problems and expected outcomes.
- Provided high-quality wound care, reducing the risk of infection and promoting timely healing.
- Educated patients and their families on disease management, medication administration, and at-home care techniques, empowering them to take control of their health.
- Provided emotional support to patients and their families during difficult times, fostering trust and rapport with those under my care.
- Contributed to infection control measures by adhering to strict hygiene protocols and educating staff on best practices.
Graduate Nurse/LVN
Valley Baptist Medical Center
01.2007 - 03.2008
- Performed skilled care to pediatric and neonatal population in a hospital setting.
- Conducted thorough assessments of new admissions to establish baseline data for ongoing monitoring and intervention planning purposes.
- Conferred with RN and LVN to identify patient care needs and support and prepare patient admission, transfer or discharge.
- Completed, maintained and submitted accurate and relevant clinical notes regarding patient condition and treatment plan to facilitate continuity of care.
- Assisted with case management upon discharge.
Education
Associates Degree Nursing -
University of Texas at Brownsville
Brownsville, Texas01.2009
License of Vocational Nursing Certificate -
University of Texas at Brownsville
Brownsville, Texas01.2007
Graduated -
Tuloso-Midway High School
Corpus Christi, Texas01.1999
Skills
- Healthcare compliance
- Quality Improvement
- Staff Development
- Training and education
- Operations Management
- Clinical Supervision
- Teamwork and Collaboration
- Problem-Solving
- Critical Thinking
- Analytical Thinking
Licensurecertifications
- RN awarded June 2009
- LVN awarded February 2008
- CPR Certified
Languages
Spanish
Native or Bilingual
Timeline
Health Service Manager
United Healthcare StarKids
02.2022 - Current
Health Service Manager
United Healthcare StarKids
02.2022 - Current
StarKids Appeals RN
United Healthcare StarKids
02.2020 - 02.2022
RN Service Coordinator
United Healthcare StarKids
05.2016 - 02.2020
ADON, RN Case Manager
Lower Valley Home Health
07.2012 - 12.2012
RN Field Nurse
Superior Home Health
11.2009 - 02.2012
RN/Case Manager
Rio Home Care
08.2009 - 11.2009
RN/Case Manager
Halo Home Health
06.2009 - 08.2009
RN Field Nurse
Superior Home Health
05.2009 - 05.2016
LVN Field Nurse/QA
Halo Home Health
04.2008 - 06.2009
Graduate Nurse/LVN
Valley Baptist Medical Center
01.2007 - 03.2008
Associates Degree Nursing -
University of Texas at Brownsville
License of Vocational Nursing Certificate -
University of Texas at Brownsville
Graduated -
Tuloso-Midway High School
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