OMAR ROSA-LOPEZ

Director of Clinical Outcomes (DCO). Responsible to oversees clinical operations, staff management, and regulatory compliance in healthcare organizations. They ensure high-quality patient care, develop policies, and maintain accurate records. Their leadership drives improvement and supports the organization's success.

Key Functions:

• Work with physicians, clinical staff, patients, and insurance plans to effectively
• Manage patients at high risk for healthcare complications
• Identify gaps in care, based on evidence-based clinical protocols.
• Identify patient barriers to care leading to improvement of quality patient outcomes.
• Report patient data to payers to help close the HEDIS measures through reports, provider portals and secure faxing.
• Report to the Vice President of Clinical Services and Senior Leadership on opportunities for improvement regarding provider group, organizational goals, and deadlines.
• Coached and trained newly hired employees so that each understood job responsibilities and requirements of positions.
• Interviewed and hired highly talented individuals bringing great skills and passion to daily jobs.
• Provide ongoing case management to patients to implement appropriate treatment plan, adhere to quality models and maximize utilization of services needed to achieve optimal outcomes.
• Supported and led clinical team with one-to-one meetings and regular group training.
• Worked with nurse manager to develop nursing staff through education, evaluation, performance management, and competency improvement.

Responsible of the operations of a medical office, I conduct various administrative tasks. Supervise the facility’s office staff, hire, and train new staff members and manage finances and budget operations. Support and provide effective communication, have excellent people skills, and am a problem solver. Manage the facility’s office staff and perform human resources duties, such as hiring and training new staff members. In addition, I handle medical records, billing, ordering equipment, and supplies, and developing and implementing strategies to improve the facility’s efficiency. Also, ensure that all the legal obligations of the medical office comply with the expectation and Joint Commission Clinical Standards.

Key Functions:

• Managed daily practice operations to optimize appointment scheduling, patient records management and billing functions.
• Provided outstanding support to entire staff which helped improve process flow and boosted efficiency.
• Ordered all office supplies and kept check on inventory levels.
• Oversaw accounting, budgeting, and financial reporting.
• Developed policies and procedures for effective practice management.
• Assessed processes and procedures, complying with OSHA, and HIPAA regulations.
• Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.

Director of Performance Outcomes retains the overall responsibility for the outreach efforts and follow-up with patients who have incurred high medical costs due to but limited to frequent ER visits, pharmacy services, and hospitalizations. Responsible for the analysis of organizational performance outcome measures. Worked closely with all TFHC Senior Leaders and Department Management Staff, and the Medical Staff Leadership team. Supporting system processes and outcomes to ensure safe, quality patient care, compliance with all standards and regulations. Implementing strategies to improve the facility’s efficiency.

Key Functions:

• Work with physicians, clinical staff, patients, and insurance plans to effectively:
• Manage patients at high risk for healthcare complications.
• Identify gaps in care based on evidence-based clinical protocols, and identify patient barriers to care leading to improvement of quality patient outcomes.
• Report patient data to payers to help close the HEDIS measures through reports, provider portals, and secure faxing.
• Report to the Vice President of Clinical Services and Senior Leadership on opportunities for improvement regarding provider group, organizational goals, and deadlines.
• Responsible for Analysis of the Clinical Data and Measurements with focus on specific regions including but limited to the following areas:
• Quality Measures Outcomes and Performance, HEDIS 5 Star Initiative
• Implemented best practice policies for patient education and patient and staff safety.

Responsible for Clinical Interface/Liaison (clinical problem solver with facilities, providers, carriers; resolution of issues concerning members, benefit interpretation, program definition, and clarification). Clinical Operations Analysis (monitors and analyzes medical management activities; provides analytical support to clinical programs; may perform clinical assessments and clinical audits)

Key functions:

• Maintained up-to-date information in electronic medical records software.
• Communicated with doctors, nurses, patients and other employees to identify and resolve healthcare needs.
• Monitored and notified senior management on expenditures and plans concerning budget and fiscal matters.
• Clinical Training (planning, coordinating, delivering, and evaluating clinical Training)
• Clinical Writing (writing nursing tools and reference information to support the design of clinical products and services)
• Clinical Program Management (development, implementation, and ongoing management and administration of a clinical program(s)
• Provides strategic oversight and support, measurement standards, and revisions as needed to deliver programs focused on quality, affordability, and outcomes.)
• Kept records of expenses and monitored budget while recommending opportunities for cost savings.

Perform medical record reviews to support improvement and compliance, abstract HEDIS data, include over-read of studies, working collaboratively with internal HEDIS Stars Team and the Quality Team. Work collaboratively with internal and external management and resources (staff and contractors) to optimize information available Responsible for assisting the providers in delivering improved patient care and decrease in hospital readmissions and misuse of emergency visits, enhancement of traditional case management programs to integrate nurses into the local provider community, support the POD case management assuring timely PCP follow-up and compliance with treatment plans for members with chronic conditions, education to the provider community on the impact of CAHPS, HOS and HEDIS on member outcomes and STARs performance, assessment of provider office practices for opportunities for improvement to positively.

Key Functions:

• Maintain organized, updated reporting of activities with clear documentation
• Reviewed production processes and identified potential quality issues.
• Inspected raw materials and finished products to verify quality and disposed items that did not meet safety requirements.
• Collaborate with the STARS Team to deliver and develop tools and resources required to provide the providers with HEDIS and STARs training and education
• Inspected items and compared against standards to meet regulatory requirements.
• Participate in provider visits to complete record reviews, collect records and educate on HEDIS STAR measures
• Complete claim research to identify the service performed, dates of service, provider type, and place of service
• Research may include multiple systems and reports
• Participate in the activities of the Quality Improvement HEDIS Stars Program

Responsible to offering case management programs to health plans members providing high-quality service to the Medicare and Medicaid (DNSP) population according to the standards and regulations of CMS and NCQA.

Key Functions:

• Capable of completing and discussing health risk assessments to better assist members with their immediate needs after hospital discharge to prevent recurrent hospitalizations; by providing education related to their benefits, medical conditions, and community resources
• Developed and implemented comprehensive case management plans to address client needs and goals.
• Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
• Assist member with authorization of services, medical equipment, and coordination of care.

Responsible for maintaining patient information confidentiality, evaluating patients, and providing comprehensive nursing care based on assessment, nursing diagnoses, plan of treatment, and establishing priorities according to patient needs. Interventions for Vital Signs, general examination, medication administration (oral, subcutaneous, IV, IM), total patient hygiene, venipuncture for iv infusion, blood extraction, dextrose monitor, blood transfusions, foley catheter insertion, management of enteral therapy, management of post operated patients, management of cardio-respiratory arrests, management of an intubated patient, management of the patient with mental disorders, education to patient and family, maintenance of security and infection control measures, communication with doctors to report patient progress or changes in conditions, appropriate documentation of patient record and others. Planned, prioritized and provided nursing care by applying advanced specialty clinical nursing knowledge and skills to support comfort and safety of patients and families.

Responsible for supervising the nursing staff, maintenance of clinic flow, employee schedule; evaluator of staff development and performance, employee and patients conflicts manager, coordinator of special services and transport of patients through 911; supplies ordering (equipment, medications, and general stores), patient assessment, medication administration (oral and IM), chart documentation, vaccines administration and responsible of vaccines program inspection, education to employee, patients and family, chart audits, supervisor of security and infection control measures, contact with pharmaceutical, equipment, and special services representatives, participation in administrative meetings. Supervised, directed, and motivated high-quality performance from nursing staff.

Responsible for maintaining patient information confidentiality, evaluating patients, and providing comprehensive nursing care based on assessment, nursing diagnoses, plan of treatment, and establishing priorities according to patient needs Interventions for Vital Signs, general assessment, medication administration (oral, subcutaneous, IV, IM), total patient hygiene, venipuncture for iv infusion, blood extraction, dextrose monitor, blood transfusions, foley catheter insertion, management of enteral therapy, administration of post operated patients, management of cardiorespiratory arrests, management of an intubated patient, management of a patient with mental disorders, education to patient and family, maintenance of security and infection control measures, communication with doctors to report patient progress or changes in conditions, appropriate documentation of patient record and others.