Michele Rodriguez
Caro,MI
Summary
Highly experienced Clinical Program Manager with strong background in healthcare and clinical operations. Possess skills in strategic planning, team leadership, process improvement and cross-functional collaboration. Demonstrated success in designing and implementing clinical programs that improve patient outcomes. Committed to driving efficiency while maintaining the highest standards of care.
Overview
31
31
years of professional experience
Work History
Clinical Review Coordinator
Optum
Brentwood, CA
08.2022 - Current
- Resolved customer complaints or answered customers' questions.
- Cross trained to work multiple health plans.
- Perform review for all direct admits to SNF.
- Performa all expedited and standard prospective reviews, including patient oral and/or written notifications.
- Coordinator peer to peer reviews with naviHealth Medical Directors.
- Notify hospitals and SNFs of review outcomes.
- Partner with Medical Directors for Pre-Service Coordinator training as needed.
- Complete processes as it relates to pre-service authorizations.
- Educate facilities on the pre-service denial process.
- Participate in the clinical phone queue to ensure customer SLA's are met.
- Support new delegated contract start-up to ensure experienced staff work with new contracts.
Occupational Therapist
First State Home Health Care
Saginaw, MI
05.2022 - Current
- Worked with interdisciplinary teams to provide comprehensive treatment and support.
- Personalized treatment plans to complement specific abilities and recovery goals of each patient.
- Consulted with patients to assess conditions, obtain histories and discuss objectives.
- Adjusted treatment plans based on in-progress evaluations and patient satisfaction.
- Maximized revenue by planning, establishing and managing effective therapy programs to attract and retain clients.
Occupational Therapist
Covenant VNA
Saginaw, MI
04.2022 - Current
- Worked with interdisciplinary teams to provide comprehensive treatment and support.
- Personalized treatment plans to complement specific abilities and recovery goals of each patient.
- Consulted with patients to assess conditions, obtain histories and discuss objectives.
- Adjusted treatment plans based on in-progress evaluations and patient satisfaction.
- Assessed and reviewed patients for discharge and planning and integrated services for patients requiring home care and durable medical equipment (DME).
Therapy Program Manager/Occupational Therapist
Therapy Management Inc
09.2019 - Current
- Responsible for transitioning therapy team seamlessly from one contract therapy company to another, while continuing to provide care to home care patients within the community.
- Expertly managed all billing therapy services to home care agency
- Audit all OT, PT, and ST documentation according to Medicare, state survey and reimbursement guidelines via 2 different EMR systems (Net Health/Rehab Optima and WellSky/Kinnser)
- Educate therapy clinicians on appropriate documentation/guidelines.
- Recruit, hire, and train highly talented individuals joining the team in order to bring expertise to organization.
- Evaluate and provide treatment to home care patients within the community.
- Resolve conflicts between physicians, nurses and administrative staff to maintain optimal workflows.
- Head clinical oversight to devise and establish policies, procedures and best practices in alignment with regulatory requirements.
- Develop and maintain positive working relationship with patients, physicians and other team members.
- Partner with interdisciplinary healthcare teams to formulate individualized treatment plans to deliver high-quality patient care.
- Communicate with patients with compassion while keeping medical information private.
- Collaborate with multi-disciplinary staff to improve overall patient care and response times.
- Lead and motivate employees through supervision, training and coaching on duties and daily operational activities.
Cluster Program Manager/Occupational Therapist
Select Rehabilitation
Frankenmuth, MI
04.2014 - 08.2019
- Managed a multi-disciplinary team of occupational, physical and speech therapists contracted for home health services
- Audited therapy documentation and educated clinicians on appropriate medically necessary documentation following Medicare guidelines.
- Completed billing and payroll for therapy staff and invoicing for contract therapy company
- Communicated and actively participated in mufti-disciplinary team meetings for coordination of home care services, quality analysis meetings and infection control/safety meetings for improvement of outcome measures and home health services
- Evaluated, planned, and provided occupational therapy treatment/education to home health patients with a wide variety of diagnoses.
- Tracked progress by employing program documentation, directives, funding information and other vital program materials.
- Helped team members improve productivity and performance through hands-on coaching in order to achieve company objectives.
- Monitored and created reports showcasing program outcomes to communicate results with clients and customers.
Occupational Therapist
Total Rehab Services
Frankenmuth, MI
01.2011 - 03.2014
- Provided contracted occupational therapy services to multiple home health agencies using several software documentation systems
- Actively participated and communicated with interdisciplinary team for coordination of care for home health patients
- Assisted with documentation review of home health charts and provided education to multidisciplinary team on improvement of documentation for reimbursement of home care services.
- Educated patients on therapy treatment plans and long-term recovery goals for physical, speech and cognitive progress.
- Personalized treatment plans to complement specific abilities and recovery goals of each patient.
- Consulted with patients to assess conditions, obtain histories and discuss objectives.
- Selected effective treatment plans in line with personal goals for home, school or work life.
- Developed rehabilitation plans that fit clients' aptitudes, education levels, physical abilities, and career goals.
- Tracked incoming patient information, intervention plans and patient responses to treatment.
- Supervised staff and conducted performance reviews for corrective action planning to ensure optimal productivity.
- Supported executive-level management by offering feedback on strategy, program and initiative effectiveness.
Program Manager/Occupational Therapist
Select Rehabilitation
Caro, MI
11.2008 - 01.2011
- Managed multi-disciplinary team providing contract therapy services for skilled nursing facility (SNF) residents
- Responsible for coordination/management of prospective payment system (PPS), therapy scheduling, and MDS education for therapy related residents
- Actively participated in inter-disciplinary meetings for coordination of care with SNF residents
- Provided innovative occupational therapy treatment to SNF residents, screened long term care residents for the need for therapy services and supervised occupational therapy assistant treatment.
- Monitored and created reports showcasing program outcomes to communicate results with clients and customers.
- Helped team members improve productivity, performance and documentation through hands-on coaching in order to achieve company objectives and appropriate reimbursement.
- Uncovered issues to determine solutions and assist program participants.
- Improved cross-departmental cooperation and information communication processes by providing presentations to staff members and administration.
- Maintained scheduling and optimal quality standards to keep audiences informed or entertained.
- Boosted performance and drove cost controls while achieving project and overall objectives to ensure customer satisfaction.
Occupational Therapist
Wellspring Lutheran Home Care
Frankenmuth, MI
09.2002 - 01.2011
- Provided occupational therapy treatment to home health patients for a wide variety of diagnoses
- Expertly educated multiple disciplines on occupational therapy services and active participant as the agency rehab representative for the Michigan Home Health Association
- Assisted with modifications to multi-disciplinary documentation to maximize staff effectiveness, patient safety/health and appropriate reimbursement of therapy services.
Program Coordinator/Occupational Therapist
Rehab Care Group
Caro, MI
01.2004 - 11.2008
- Responsible for management of financial performance of contracted therapy services of SNF and completed clinical documentation audits to ensure highest level of quality documentation for therapy services
- Provided occupational therapy services to several types of diagnoses within SNF, supervised COTA treatment, and screened long term residents of SNF to determine the need for appropriate therapy services
- Managed PPS and trained occupational, physical and speech therapy team contracted to SNF on computer documentation system, new hire orientation and quality improvement of medically necessary therapy documentation.
Occupational Therapist
Complete Rehabilitation Services
Troy, MI
08.2003 - 01.2004
- Provided contract occupational therapy treatment to two different skilled nursing facilities
- Assisted staff with education of PPS (prospective payment system) policies/guidelines and improving therapy documentation according to Medicare and state guidelines.
- Specialized in positioning, restraint reduction and orthotics for residents of SNF.
Area Manager/Occupational Therapist
Generation Rehabilitation
Grand Haven, MI
05.2000 - 01.2002
- Managed rehabilitation departments within three different SNF facilities and educated therapy teams on medically necessary documentation.
- Responsible for hiring, orienting, and scheduling therapists for these SNFs
- Provided occupational therapy services as needed within same facilities
- Mentored and supervised COTAs and students
- Completed certificate of achievement for the Management of Feeding and Swallowing Disorders for Occupational Therapists.
Program Manager/Occupational Therapist
Select Rehabilitation
Kalamazoo, MI
09.1999 - 05.2000
- Marketed therapy services to SNF throughout southwest Michigan
- Managed and educated rehab staff on documentation auditing
- Contact person for PPS regulations/policies with 5 SNFs
- Trained staff and supervised COTAs
- Mentored staff OT and provided OT services as needed within SNFs.
Program Manager/Occupational Therapist
Service Master Rehabilitation
Kalamazoo, MI
11.1998 - 09.1999
- Developed rehabilitation plans for Rehab Department at SNF that fit clients' aptitudes, education levels, physical abilities, and career goals.
- Coordinated PPS documentation and maintained requirements for department
- Provided occupational therapy services for two SNFs and supervised COTAs.
Facility Coordinator/Occupational Therapist
Concept Rehabilitation
South Haven, MI
04.1997 - 11.1998
- Managed and coordinated occupational, physical and speech therapy services for two SNFs
- Trained and oriented new staff and supervised COTA
- Contact person for restraint reduction and actively participated in interdisciplinary rehab meetings within SNF
- Provided occupational therapy services to a wide variety of diagnosis within three SNFs.
Occupational Therapist
Lakeland Medical Center
St. Joseph, Ml
01.1994 - 04.1997
- Provided occupational therapy services for acute care, inpatient rehabilitation, outpatient and home health care settings within regional health system
- Created Visual Scan Board and Visual/Perceptual test notebook for rehab department
- Active member of interdisciplinary stroke team, Case Record Review and Patient/Family Involvement committees
- Inserviced/educated staff and supervised level I/II occupational therapy and occupational therapy assistant students.
Education
B.S - Occupational Therapy
WESTERN MICHIGAN UNIVERSITY
12.1993
Skills
- Occupational Therapist License- State of Michigan
- NBCOT Certification
- Budget Analysis & Forecasting
- Expense Monitoring
- Data Management
- Clinical Development and Operations
- Personnel Management
- Acute and Rehabilitative Care
- Operational Oversight
- Healthcare Delivery
- Records Maintenance
- Critical Thinking
- Training & Development
- Collaborative Teamwork
- Verbal and Written Communication
- Customer Service
- Monitoring plan development
- Developing training programs
- Regulatory compliance
- Supervisory experience
- Compliance with regulatory guidelines
References
References available upon request
Timeline
Clinical Review Coordinator
Optum
08.2022 - Current
Occupational Therapist
First State Home Health Care
05.2022 - Current
Occupational Therapist
Covenant VNA
04.2022 - Current
Therapy Program Manager/Occupational Therapist
Therapy Management Inc
09.2019 - Current
Cluster Program Manager/Occupational Therapist
Select Rehabilitation
04.2014 - 08.2019
Occupational Therapist
Total Rehab Services
01.2011 - 03.2014
Program Manager/Occupational Therapist
Select Rehabilitation
11.2008 - 01.2011
Program Coordinator/Occupational Therapist
Rehab Care Group
01.2004 - 11.2008
Occupational Therapist
Complete Rehabilitation Services
08.2003 - 01.2004
Occupational Therapist
Wellspring Lutheran Home Care
09.2002 - 01.2011
Area Manager/Occupational Therapist
Generation Rehabilitation
05.2000 - 01.2002
Program Manager/Occupational Therapist
Select Rehabilitation
09.1999 - 05.2000
Program Manager/Occupational Therapist
Service Master Rehabilitation
11.1998 - 09.1999
Facility Coordinator/Occupational Therapist
Concept Rehabilitation
04.1997 - 11.1998
Occupational Therapist
Lakeland Medical Center
01.1994 - 04.1997
B.S - Occupational Therapy
WESTERN MICHIGAN UNIVERSITY
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