Rosalie De Guzman
San Jose
Summary
Dedicated nursing professional with a strong background in geriatric care and resource utilization management. Skilled in developing individualized treatment plans and ensuring compliance with regulatory standards, leading to improved patient satisfaction and quality of care.
Overview
36
36
years of professional experience
Work History
MDS Coordinator RN
Sunnyview Care Center
Cupertino, CA
07.2025 - Current
- Conducted comprehensive assessments to develop accurate patient care plans.
- Collaborated with interdisciplinary teams to ensure compliance with regulatory standards.
- Managed documentation of Minimum Data Set (MDS) submissions for quality assurance.
- Assisted in coordinating resident care services to enhance overall quality of care.
- Monitored patient progress and identified changes in conditions for timely interventions.
- Set schedules for staff to start and complete MDS assessments and care plan meetings.
- Ensured timely completion of all MDS assessments, maintaining full compliance with federal and state regulations.
- Maintained up-to-date knowledge on CMS guidelines and changes to ensure accuracy in reporting and reimbursement processes.
- Verified prompt and accurate completion of MDS activities for billing.
- Collaborated closely with therapy departments to accurately capture rehabilitation needs within MDS documentation, supporting appropriate resource allocation for residents'' needs.
- Enhanced patient care quality by implementing comprehensive MDS assessments and care plans.
- Established regular review processes to evaluate the accuracy and completeness of MDS records, leading to proactive identification of potential issues before they escalate.
RN Case Manager
Kaiser Permanente
Santa Clarita, CA
03.2024 - 01.2026
- Managed patient care plans to ensure comprehensive and coordinated treatment strategies.
- Conducted thorough assessments of patient needs, identifying barriers to care and facilitating solutions.
- Collaborated with multidisciplinary teams to optimize patient outcomes and enhance service delivery.
- Developed educational materials for patients, promoting self-management and adherence to treatment regimens.
- Monitored progress of cases, adjusting plans based on evolving patient conditions and feedback.
- Utilized electronic health record systems to document interactions and track patient progress effectively.
- Advocated for patients' needs within healthcare systems, ensuring access to necessary resources and services.
- Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
- Collaborated closely with physicians to develop individualized treatment plans, supporting optimal patient outcomes.
- Reduced hospital readmission rates through effective case management and patient education on self-care techniques.
- Served as a key liaison between patients, families, and healthcare providers, fostering open communication and trust among all parties involved in the care process.
- Managed support services and fostered communication among social workers, therapists, hospital staff, and patients.
- Improved patient satisfaction scores by providing timely follow-ups and addressing concerns promptly.
- Streamlined discharge planning processes, ensuring a smoother transition for patients back to their homes or other facilities.
- Advocated for patients with insurance companies, securing coverage for necessary treatments and medications.
- Streamlined discharge planning, ensuring patients received necessary resources and support for recovery at home.
- Analyzed case management data to identify trends and develop strategies for continuous improvement in patient care.
RN Staff Nurse
Clipboard Registry
San Jose, CA
11.2022 - 05.2025
- Administered medications and treatments in accordance with established protocols.
- Collaborated with interdisciplinary teams to develop individualized patient care plans.
- Monitored and assessed patient conditions, adjusting care strategies as needed.
- Educated patients and families on health management and post-discharge care.
- Implemented effective time-management strategies to optimize productivity while maintaining high-quality patient care standards.
- Managed complex wound care cases using advanced skills in assessment, dressing application, and infection control measures.
- Reduced medication errors through meticulous administration and documentation of medications.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Developed and implemented individualized patient care plans for optimal outcomes.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Implemented medication and IV administration, catheter insertion, and airway management.
- Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
- Delivered high level of quality care to diverse populations while overseeing patient admission and triaging based on acuity and appropriate department admission.
MDS Coordinator RN
Plum Tree Care Center
Los Gatos, CA
04.2018 - 03.2024
- Coordinated interdisciplinary team meetings to enhance patient care planning and compliance.
- Implemented MDS assessments to ensure accurate documentation and reimbursement processes.
- Trained staff on regulatory guidelines and best practices for resident assessments.
- Streamlined data collection procedures, improving efficiency in the MDS submission process.
- Monitored quality indicators to identify areas for improvement in resident care outcomes.
- Analyzed resident data trends to inform strategic decision-making for quality improvement initiatives.
- Assessed electronic medical record for required documentation to support MDS coding.
- Collaborated with nursing staff to provide accurate and timely clinical assessments for each resident, leading to improved overall care.
- Completed minimum data set assessments with strong collaboration across business, provider and clinical disciplines.
- Led weekly utilization review to go over recent clinical activities.
- Developed strong relationships with interdisciplinary team members to facilitate efficient collaboration on resident care planning.
- Provided guidance to nursing staff on accurate completion of Section GG assessments, enhancing overall documentation quality and supporting appropriate Medicare/Medicaid reimbursement rates.
- Complied with federal and state regulations for completion and coordination of RAI process.
- Improved communication between departments by establishing clear protocols regarding assessment timelines, leading to more efficient care planning processes.
- Reviewed missing assessment reports and analyzed issues for leadership team.
- Achieved significant improvements in MDS accuracy and timeliness, recognized by facility leadership.
- Participated in quality assurance reviews to verify accuracy and reliability of data.
- Implemented evidence-based fall prevention strategies, resulting in a significant decrease in patient falls within the unit.
- Provided skilled, timely and level-headed emergency response to critically-ill patients.
MDS RN
Mission Nursing and Rehabilitation Center
Santa Clara, CA
04.2010 - 04.2018
- Mentored nursing staff on MDS documentation processes, enhancing accuracy and efficiency in reporting.
- Analyzed resident data trends to identify opportunities for enhanced care interventions and resource allocation.
- Implemented quality improvement initiatives that elevated overall resident satisfaction scores within the facility.
- Provided ongoing education for nursing staff regarding MDS best practices, contributing to a knowledgeable and skilled workforce.
- Monitored changing regulations related to RAI/MDS requirements, keeping staff informed about updates that impact their daily work routines.
- Supported facility-wide initiatives aimed at reducing hospital readmissions by closely monitoring MDS data for trends and potential areas of concern.
- Identified areas of improvement in the facility''s quality measures through thorough analysis of MDS data, resulting in targeted interventions and better outcomes for residents.
- Supported resident families with clear communication, providing updates on care plans and answering questions about MDS process.
- Contributed to interdisciplinary team meetings by presenting relevant clinical data about patients'' progress toward reaching established goals of care.
- Monitored patient reactions after administering medications and IV therapies.
- Ensured timely completion of all MDS assessments, maintaining full compliance with federal and state regulations.
- Enhanced patient care quality by implementing comprehensive MDS assessments and care plans.
- Completed minimum data set assessments with strong collaboration across business, provider and clinical disciplines.
RN Charge Nurse Sub Acute Unit
A Grace Sub Acute & Skilled Care
San Jose, CA
12.2005 - 04.2010
- Charge nurse for sub acute patients with traches and vents; GT feedings., IV antibiotics.
- Administered medications and treatments according to established protocols and patient care plans.
- Monitored vital signs, assessing patient conditions to ensure timely interventions.
- Collaborated with interdisciplinary teams to develop and implement individualized care strategies.
- Educated patients and families on health management, promoting understanding of treatment options.
- Prevented the spread of infections by consistently adhering to strict infection control protocols and educating patients on proper hygiene practices.
- Skillfully managed challenging patient situations using de-escalation techniques, crisis intervention strategies, and therapeutic communication skills.
- Educated family members and caregivers on patient care instructions.
- Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.
- Supervised and managed daily scheduling, tasking, and administration.
- Coordinated discharge planning, collaborating with patients, families, and healthcare providers to ensure seamless transitions of care.
- Implemented care plans for patient treatment after assessing physician medical regimens.
- Managed patients recovering from medical or surgical procedures.
- Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
- Monitored patient reactions after administering medications and IV therapies.
- Responsible for admissions and discharges.
Charge Nurse
19th Ave Healcare Center
11.2000 - 08.2005
- Charge nurse in a skilled setting for patients in a long term care facility
- Administered medications and treatments for assigned patients.
- Responsible for admissions and discharges.
- Supervised nursing staff to ensure high-quality patient care and compliance with healthcare standards.
- Streamlined shift handovers, ensuring seamless continuity of care and minimizing information gaps.
- Maintained high standards of patient care during high-volume shifts, managing patient assignments to optimize nurse workload.
- Monitored patient reactions after administering medications and IV therapies.
- Developed and implemented care plans in collaboration with multidisciplinary teams to improve patient outcomes.
- Mentored junior nurses in clinical skills and best practices, fostering a culture of continuous learning.
- Conducted assessments of patient conditions, prioritizing interventions based on urgency and complexity.
OR Nurse
Medical Center Manila
Philippines
09.1990 - 07.1997
- Collaborated with surgical teams to ensure optimal patient care and safety protocols.
- Implemented infection control measures, enhancing overall patient outcomes in the OR.
- Evaluated and improved workflow efficiency within the operating room environment.
- Promoted patient satisfaction with compassionate care during preoperative preparation, intraoperative support, and postoperative recovery.
- Assisted surgeons during operations, ensuring smooth transitions between steps and minimizing errors.
- Continuously updated professional knowledge, participating in ongoing training opportunities and workshops.
- Maximized OR efficiency by implementing innovative strategies for time management and resource allocation.
- Maintained accurate documentation of all relevant medical information, promoting effective communication among healthcare providers.
- Successfully managed multiple cases simultaneously, demonstrating adaptability under high-pressure situations.
- Managed surgical inventory, maintaining adequate levels of supplies for all scheduled surgeries.
- Utilized sterile techniques and infection-control guidelines to maintain clean and safe environment.
- Collected, labeled, and transported specimens and delivered to lab for testing.
- Prepped operating rooms to comply with environmental asepsis standards.
- Assisted in the development of surgical care plans tailored to individual patient needs.
- Trained new nursing staff on operating room protocols and equipment usage.
Education
Bachelor of Science - Nursing
Emilio Aguinaldo College
Manila Philippines03-1989
High School Diploma -
Our Lady Of Remedies Academy
Philippines03-1985
Skills
- HIPAA compliance
- Electronic health records proficiency
- Medical record management
- Research and data collection
- Care planning
- Long-term care experience
- Case management experience
- Medicare reimbursement knowledge
- MDS software familiarity
- Geriatric nursing expertise
- Resource utilization management
Timeline
MDS Coordinator RN
Sunnyview Care Center
07.2025 - Current
RN Case Manager
Kaiser Permanente
03.2024 - 01.2026
RN Staff Nurse
Clipboard Registry
11.2022 - 05.2025
MDS Coordinator RN
Plum Tree Care Center
04.2018 - 03.2024
MDS RN
Mission Nursing and Rehabilitation Center
04.2010 - 04.2018
RN Charge Nurse Sub Acute Unit
A Grace Sub Acute & Skilled Care
12.2005 - 04.2010
Charge Nurse
19th Ave Healcare Center
11.2000 - 08.2005
OR Nurse
Medical Center Manila
09.1990 - 07.1997
Bachelor of Science - Nursing
Emilio Aguinaldo College
High School Diploma -
Our Lady Of Remedies Academy