Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Olivia Esquivel

McAllen,TX

Summary

Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Hardworking adaptable and resilient veteran nurse with strong worth ethic and strong attention to detail. Bringing in 36-year record of success in nursing seeking RN Supervisor position with the National Letter Team of United HealthCare. Motivated to learn, grow and excel in new role.

Overview

34
34
years of professional experience
1
1
Certification

Work History

Team Lead Clinical Admin RN Consultant

United HealthCare
McAllen, TX
12.2020 - Current
  • Understands state regulations/contractual requirements as it relates to timeframes, reading grade levels, template and health literacy requirements.
  • Effective Queue Management: Monitor Compliance and notify Supervisors/Program Managers of any potential compliance concerns. Monitor Auto-Routing performance.
  • Route cases as necessary based on TAT, priority, and/or specific policy requirements.
  • Meets regulatory turn around time by prioritizing workload to ensure TAT compliance.
  • Clear out all TAT due cases from main queue.
  • Review all MD outreach emails and respond to any emails requiring escalation by Team Lead.
  • Evaluate staff performance by performing Quality Audits. Performs five [5] monthly audits on nine [9] QR nurses and provide coaching to address inefficiencies that may have been found.
  • Educate staff on organizational mission and goals to help employees achieve success.
  • Identify training opportunities within team.
  • Assists with special projects as assigned by department manager.

Sr Clinical Admin RN

United HealthCare
McAllen, TX
08.2015 - 12.2020
  • Coordinate internal reviews on denial letters to determine compliance with contractual and regulatory requirements of State and Federal programs, while reviewing for efficiencies and effectiveness of procedures
  • Performs internal Quality Control reviews on processes and activities while developing recommendations for improvement
  • Proficient in interpreting benefits, contracts, and medical policy
  • Review denial notice issued by the National Letter team to ensure accuracy and compliance, as well as providing recommendations for improvement, as needed
  • Maintain knowledge of State rules, contracts and Federal legislation/regulations as well as UHG guidelines
  • Establish and maintain good working relationships throughout the company to support goals and objectives
  • Demonstrate flexibility, availability and dependability to conform to position responsibilities
  • Ability to work independently or in a team environment
  • Consistently exceeding production while still maintaining 100% quality
  • Trained in C&S, M&R, E&I and in letter writing

RN Case Manager

United HealthCare
McAllen, TX
01.2012 - 08.2015
  • Consulted with clinicians to devise and manage effective ongoing care plans for at-risk patients.
  • Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations and procedural costs.
  • Conducted regular re-evaluations to address changes in needs and conditions, introducing revisions to care plans as needed.
  • Reduced care costs without sacrificing quality through effective service coordination and multidisciplinary collaboration.
  • Authored initial assessments of patients and family to develop plans for individual home care needs.
  • Worked with suppliers and vendors on provision of medical equipment, items and services.
  • Examined patients and documented history of current and previous conditions, illnesses, injuries and current medications.
  • Created individualized care plans based on nursing diagnosis and incorporated appropriate nursing methods to achieve positive outcomes.
  • Updated patient charts using CareOne with data such as medications to keep records current and support accurate treatments.
  • Evaluated healthcare needs, goals for treatment and available resources of over 50 members and connected to optimal providers and care.

Hospice Registered Nurse

Selah Hospice Care
McAllen, TX
03.2013 - Current
  • Established hospice care services for elderly and disabled patients.
  • Established and maintained successful relationships with patients, families and physicians by utilizing exemplary communication and active listening skills.
  • Developed and implemented individualized care plan for each hospice patient while following physician instructions.
  • Taught family members and caregivers various ways to manage patients' pain, how to check for vital signs and proper methods for dressing changes.
  • Sustained quality standards by performing routine medication audits and upholding internal and industry best practices.
  • Delivered high level of quality care to diverse populations while overseeing patient admission and triaging based on acuity and appropriate department admission.
  • Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
  • Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process and management and lifestyle options.
  • Responded to incoming calls from patient, family member or caregiver for after-hours medical services and gathered information to address inquiry or concern and ascertain need to conduct in-person nursing visit.

Sr. VP of PHC/CBA & CCP/MDCP

Health Care Unlimited Inc.
McAllen, TX
11.1997 - 08.2011
  • Drove corporate revenue by creating strategies that fit perfectly with company's vision and mission.
  • Led restructuring and turnaround through development of new leadership team.
  • Presented and discussed strategy and initiative progress with senior business leaders.
  • Developed measurement tools, dashboards and reports to track metrics on adoption and effectiveness of initiatives.
  • Identified opportunities to improve business process flows and overall departmental productivity.
  • Supervised daily operations of multiple programs across agency.
  • Increased company growth through effective collaboration with sales and marketing departments.
  • Hired and trained licensed and unlicensed staff to work in programs following rules and regulations set forth by TDHS, DADS & TMHP.
  • Teamed with Leadership department to create organization's mission and vision statements.
  • Hired and managed 100-150 employees to maximize productivity while training staff on best practices and protocols.
  • Integral part in preparing for Joint Commission Surveys developing or modifying policies / procedures to reflect changes in Joint Commission Standards

Education

Bachelor of Science - Nursing

The University Of Texas Rio Grande Valley
Edinburg, TX
12.2018

Associate Degree in Nursing -

The University Of Texas Rio Grande Valley
Edinburg, TX
05.1986

Skills

  • Coordinate internal reviews on denial letters to determine compliance with contractual and regulatory requirements of the State and Federal programs, while reviewing for efficiencies and effectiveness of procedures
  • Maintain knowledge of State rules, Contracts and Federal legislation/regulations as well as UHG guidelines
  • Effective Queue Management: Monitor Compliance and notify Supervisors/Program Managers of any potential compliance concerns Monitor Auto-Routing performance
  • Route cases as necessary based on TAT, priority, and/or specific policy requirements
  • Review denial notice issued by the National Letter Team to ensure accuracy and compliance, as well as providing recommendations for improvement, as needed
  • Performs internal Quality Control reviews on processes and activities while developing recommendations for improvement
  • Establish and maintain good working relationships throughout the company to support goals and objectives
  • Demonstrate flexibility, availability and dependability to conform to position responsibilities
  • Ability to work independently or in a team environment

Certification

  • Certified Case Manager

Timeline

Team Lead Clinical Admin RN Consultant

United HealthCare
12.2020 - Current

Sr Clinical Admin RN

United HealthCare
08.2015 - 12.2020

Hospice Registered Nurse

Selah Hospice Care
03.2013 - Current

RN Case Manager

United HealthCare
01.2012 - 08.2015

Sr. VP of PHC/CBA & CCP/MDCP

Health Care Unlimited Inc.
11.1997 - 08.2011

Bachelor of Science - Nursing

The University Of Texas Rio Grande Valley

Associate Degree in Nursing -

The University Of Texas Rio Grande Valley

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