Rosalinda Romero
Brawley,CA
Summary
Compassionate and dedicated nurse with 30 years of diverse nursing experience. Most favorable experiences have been telephonic case-management for a Medi-Cal Health Maintenance Organization and being part of establishing a new HMO set up in a rural region, Imperial County. Committed to excelling in meeting the needs of the members and providers while maintaining job responsibilities and measures required by the employer. Second language is Spanish, which has been favorable for Spanish speaking members. Remote experience includes working independently, self-starter, flexible, tech-savvy, problem solver, excel in time management, conflict resolution, and communication, clinical review, use of EHR. Accomplished in developing and actualizing strategies and programs to enhance patient care and coordinate interdisciplinary support teams. Experienced nursing professional bringing demonstrated clinical expertise, leadership skills and technical knowledge. Proficient in updating charts, monitoring medications and working with multidisciplinary teams to optimize patient care. Quality-driven and efficient with strong interpersonal abilities.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Part-time RN
Los Robles Hospice
San Diego, CA
11.2023 - Current
- Perform ongoing evaluations of patients and document findings in patient charts with detailed observation notes
- Develop care plans for patients and adapt these plans as patient needs change
- Including administering medication and various treatments as outlined
- To fulfill this duty, we collaborate with other nurses, attending physicians, and medical team members
- Check and record patient vital signs in charts, alerting other medical personnel to any potentially dangerous readings
- Prepare family members for the eventual death of patients and direct them toward available support services to help them through this process
- Notify attending physicians, staff members, and family members of patient deaths when they occur.
Clinical Manager
Bridge Home Health
San Diego, CA
04.2022 - 11.2023
- Review and evaluate each case by reviewing the services provided by clinicians, conferences, record review, discuss, instruct and guide clinicians to promote more effective performance and deliver quality care home health services following CMS standards of care
- Review patient’s clinical diagnosis, medications, procedure and clinical course
- Assist clinician in establishing plan of care
- Attend case conference meetings to facilitate coordination of care
- Assist in revision and implementation of processes and policies.
RN case-manager
Alignment Healthcare
Orange, CA
05.2021 - 01.2022
- Completed Health Risk Assessment for all members
- Assessment of patient’s condition, understanding of his/her dx and the patient's ability to follow the treatment plan
- Contacted members to discuss their course of progress and need utilizing available discharge information (if there was a hospitalization) and the initial needs assessment
- Assisted with services required coordinating services with the health care team to eliminate duplication of service and conserve health benefit dollars
- Identified problems, anticipated complication and acted to avoid them, providing health instruction to the member and family and referring the member back to the physician or other health care team members when appropriate
- Identified plateaus, improvements, regressions and depressions; counseling accordingly and recommending help
- Made personal visits or contacted the physician to clarify diagnosis, prognosis, therapies, activities of daily living, etc
- Followed up on authorizations/referrals for any modalities of treatment recommended; investigation and suggesting alternative treatments when appropriate
- Assisted with obtaining information and forms regarding living wills, health care proxy, do-not-resuscitate order, etc
- Documented case summary based on information received and communicates with the beneficiaries and involved providers
- Conducted personal visits to the member’s home or hospital
- Facilitated transfers of beneficiaries throughout the different regions and within the region by collaborating with the providers to transition the beneficiary with minimal disruption of their health care services.
RN Part-time
Accent Hospice Care
El Centro, CA
12.2020 - 09.2021
- Performed ongoing evaluations of patients and documented findings in patient charts with detailed observation notes
- Developed care plans for patients and adapted these plans as patient needs change
- Including administering medication and various treatments as outlined
- To fulfill this duty, we collaborate with other nurses, attending physicians, and medical team members
- Checked and recorded patient vital signs in charts, alerting other medical personnel to any potentially dangerous readings
- Prepared family members for the eventual death of patients and direct them toward available support services to help them through this process
- Notified attending physicians, staff members, and family members of patient deaths when they occur
- Followed orders set given by physicians regarding patient care.
RN Case-Manager
Healthnet
Woodland Hills, CA
06.2020 - 09.2020
- Completed Health Risk Assessment for all members
- Assessment of patient’s condition, understanding of his/her dx and the patient's ability to follow the treatment plan
- Contacted members to discuss their course of progress and need utilizing available discharge information (if there was a hospitalization) and the initial needs assessment
- Assisted with services required coordinating services with the health care team to eliminate duplication of service and conserve health benefit dollars
- Identified problems, anticipated complication and acted to avoid them, providing health instruction to the member and family and referring the member back to the physician or other health care team members when appropriate
- Identified plateaus, improvements, regressions and depressions; counseling accordingly and recommending help
- Made personal visits or contacted the physician to clarify diagnosis, prognosis, therapies, activities of daily living, etc
- Followed up on authorizations/referrals for any modalities of treatment recommended; investigation and suggesting alternative treatments when appropriate
- Assisted with obtaining information and forms regarding living wills, health care proxy, do-not-resuscitate order, etc
- Documented case summary based on information received and communicates with the beneficiaries and involved providers
- Conducted personal visits to the member’s home or hospital
- Facilitated transfers of beneficiaries throughout the different regions and within the region by collaborating with the providers to transition the beneficiary with minimal disruption of their health care services
- Collaborated with the physicians, member/families, and involved providers to evaluate the beneficiary needs and ensure members are receiving adequate services to meet their needs
- Provided referrals to community resources that are available for the members’ needs
- Facilitated in identifying HEDIS gaps and coordinate with providers and members to ensure HEDIS measures are met
- Participated in weekly rounds and provided a SBAR of members who were either high utilization, recent post discharge of hospital or nursing facility.
RN Case-Manager
Healthnet
Woodland Hills, CA
05.2018 - 04.2019
- Case-management of seniors and people with disabilities: with catastrophic illnesses, multiple co-morbidities including AIDS, Cancer, traumatic brain injuries, drug addiction and multiple social barriers to care
- Completed Health Risk Assessment for all members
- Assessment of patient’s condition, understanding of his/her dx and the patient's ability to follow the treatment plan
- Contacted members to discuss their course of progress and need utilizing available discharge information (if there was a hospitalization) and the initial needs assessment
- Assisted with services required coordinating services with the health care team to eliminate duplication of service and conserve health benefit dollars
- Identified problems, anticipated complication and acted to avoid them, providing health instruction to the member and family and referring the member back to the physician or other health care team members when appropriate
- Identified plateaus, improvements, regressions and depressions; counseling accordingly and recommending help
- Made personal visits or contacted the physician to clarify diagnosis, prognosis, therapies, activities of daily living, etc
- Followed up on authorizations/referrals for any modalities of treatment recommended; investigation and suggesting alternative treatments when appropriate
- Assisted with obtaining information and forms regarding living wills, health care proxy, do-not-resuscitate order, etc
- Documented case summary based on information received and communicates with the beneficiaries and involved providers
- Conducted personal visits to the member’s home or hospital
- Facilitated transfers of beneficiaries throughout the different regions and within the region by collaborating with the providers to transition the beneficiary with minimal disruption of their health care services
- Collaborated with the physicians, member/families, and involved providers to evaluate the beneficiary needs and ensure members are receiving adequate services to meet their needs
- Provided referrals to community resources that are available for the members’ needs
- Facilitated in identifying HEDIS gaps and coordinated with providers and members to ensure HEDIS measures are met
- Participated in weekly rounds and provided a SBAR of members who were either high utilization, recent post discharge of hospital or nursing facility.
Home Health RN
Healthy Living
El Centro, CA
01.2017 - 01.2018
- Provided home health care as needed during the week and on weekends
- Admitted patients to services and complete clinical documentation
- Assessed individual status and care/instruction needed by the patient using NCQUA and Medicare standards
- Conferred with physician to develop the initial plan of treatment based on physician's orders and initial patient assessment
- Provided hands-on care, case management and evaluation of the care plan, and education of the patient utilizing Care Notes
- Revise plan in consultation with physician based on ongoing assessments
- Supervision of LVN’s.
RN Case-Manager
Healthnet
Woodland Hills, CA
01.2015 - 01.2017
- Case-management of senior and people with disabilities: with catastrophic illnesses, multiple co-morbidities including AIDS, Cancer, traumatic brain injuries, drug addiction and multiple social barriers to care
- Completed Health Risk Assessment for all members
- Assessment of patient’s condition, understanding of his/her dx and the patient's ability to follow the treatment plan
- Contacted members to discuss their course of progress and need utilizing available discharge information (if there was a hospitalization) and the initial needs assessment
- Assisted with services required coordinating services with the health care team to eliminate duplication of service and conserve health benefit dollars
- Identified problems, anticipated complication and acted to avoid them, providing health instruction to the member and family and referring the member back to the physician or other health care team members when appropriate
- Identified plateaus, improvements, regressions and depressions; counseling accordingly and recommending help
- Made personal visits or contacted the physician to clarify diagnosis, prognosis, therapies, activities of daily living, etc
- Followed up on authorizations/referrals for any modalities of treatment recommended; investigation and suggesting alternative treatments when appropriate
- Assisted with obtaining information and forms regarding living wills, health care proxy, do-not-resuscitate order, etc
- Documented case summary based on information received and communicates with the beneficiaries and involved providers
- Conducted personal visits to the member’s home or hospital
- Facilitated transfers of beneficiaries throughout the different regions and within the region by collaborating with the providers to transition the beneficiary with minimal disruption of their health care services
- Collaborated with the physicians, member/families, and involved providers to evaluate the beneficiary needs and ensure members are receiving adequate services to meet their needs
- Provided referrals to community resources that are available for the members’ needs
- Facilitated in identifying HEDIS gaps and coordinate with providers and members to ensure HEDIS measures are met
- Participated in weekly rounds and provided a SBAR of members who were either high utilization, recent post discharge of hospital or nursing facility.
RN Case-manager/ part-time
Gentiva Home Health
El Centro, CA
01.2014 - 01.2015
- Provide home health care as needed during the week and on weekends
- Admit patients to services and complete clinical documentation
- Assess individual status and care / instruction needed by the patient
- Confer with physician to develop the initial plan of treatment based on physician's orders and initial patient assessment
- Provide hands-on care, case management and evaluation of the care plan, and education of the patient utilizing Gentiva Care Notes
- Revise plan in consultation with physician based on ongoing assessments.
RN Case-Manager II
California Health and Wellness Plan
Imperial/Sacramento, CA
01.2013 - 01.2014
- Onsite RN for Clinica Del Pueblo Salud, provider 20,000 Medi-Cal/managed care members
- Provided staff with education and assisted with navigation of managed-care process including the following: Prior Authorizations, Continuation of Care, Redirection of member to participating providers, CHWP provider portal utilization, Case-management, Enrollment, HEDIS Measures, Vendors; Logisticare, Alere, Nutur, Nurse Wise, Pharmacy/drug formulary
- Coordinated with CHWP Provider relations with any provider/claims issues and provided with resolution
- Provided case-management of referrals made by staff, including on-site face to face assessment, coordination of care with LCSW, collaboration with local agencies, including Cancer Resource Center of the Desert, Imperial County Public Health Dept
- And assistance with coordination of care with members and providers to facilitate continuity of care
- Coordination of meetings with providers to collaborate with their new Diabetic program, and include CHWP vendors (DM disease management program, Logisticare, Nurse Wise) and also to include local Public Health dept who were offering nutrition sessions
- Follow up with staff’s Prior Authorization submission that are pending and performance of clinical review, including using Interqual criteria and provide notification of approval or denial
- Face to face visits with large provider: Pioneers Memorial Hospital District
- Assist with navigation of manage-care process, including Prior Authorization, Diagnostics, facilitated communication with CHWP medical management staff
- Continuity of Care team: Provided Continuity of Care review for covered counties in Southern and Northern CA
- Coordinated with Medical Director
- Inpatient concurrent review: Assisted with concurrent review using Interqual criteria in Imperial County hospitals.
RN Case-Manager- Telecommute
Healthnet
Fresno, CA
01.2011 - 01.2013
- Case-management of seniors and people with disabilities: with catastrophic illnesses, multiple co-morbidities including AIDS, Cancer, traumatic brain injuries, drug addiction and multiple social barriers to care
- Home visits with high acuity members to assess member and home environment, ascertain its understanding of the patient's diagnosis and prognosis and it ability to provide caregiver support.
Education
Associates Degree -
Imperial Valley College
01.1992
Skills
- Proficient in EMR
- Proficient in operating system of Windows and Mac OS, office suites of Microsoft office, G Suite, presentation software of PowerPoint and Keynote, spreadsheets of Excel and Google Spreadsheets, and communication and collaboration tools of Skype, Zoom, Google Meets
- Speak, read, and write fluent Spanish
- Chronic Disease Management
- Quality Improvement
- Care Coordination
- Palliative Care
- Healthcare regulations
- Discharge Planning
- HIPAA Compliance
- Utilization review
- Community Resources
- Medication Management
- Insurance knowledge
- Electronic Recordkeeping
- Care Planning
- Utilization reviews
- Community Resource Referrals
- Interdisciplinary Collaboration
- Resource Management
- Policy Adherence
- Patient Care and Education
- Disease management
- Referral Generation
- Healthcare knowledge
- Case Management
- Care Delivery
- Regulatory Compliance
- Patient Counseling
Affiliations
Forgotten Angels non-profit group coordinator /member, Niland, CA
Lead for Imperial Valley Mental Health Ministry
Professional Qualifications
486953, 4206410, True, 2020
Personal Information
Title: RN, CCM
Accomplishments
- Gentiva Home Care Specialist of the year in 2011
Certification
- Registered Nurse license in the state of CA, 486953
- Certified Case-Manager, 4206410
- Strategic Intervention Life Coach
- Botox Certification 2020
Languages
Spanish
Professional
References
References available upon request.
Timeline
Part-time RN
Los Robles Hospice
11.2023 - Current
Clinical Manager
Bridge Home Health
04.2022 - 11.2023
RN case-manager
Alignment Healthcare
05.2021 - 01.2022
RN Part-time
Accent Hospice Care
12.2020 - 09.2021
RN Case-Manager
Healthnet
06.2020 - 09.2020
RN Case-Manager
Healthnet
05.2018 - 04.2019
Home Health RN
Healthy Living
01.2017 - 01.2018
RN Case-Manager
Healthnet
01.2015 - 01.2017
RN Case-manager/ part-time
Gentiva Home Health
01.2014 - 01.2015
RN Case-Manager II
California Health and Wellness Plan
01.2013 - 01.2014
RN Case-Manager- Telecommute
Healthnet
01.2011 - 01.2013
Associates Degree -
Imperial Valley College
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