Victoria Torres
San Antonio
Summary
Dynamic MDS Case Manager with a proven track record at Creative Solutions in Healthcare, excelling in compliance and reimbursement processes. Demonstrates effective organizational skills and clear communication, ensuring accurate MDS coding and optimal care coordination. Adept at managing multiple tasks while fostering collaboration among interdisciplinary teams to enhance resident outcomes.
Overview
25
25
years of professional experience
Work History
Regional Reimbursement Specialist
Creative Solutions in Healthcare
02.2019 - Current
- Ensured compliance with clinical reimbursement regulations and collaborated with facilities on internal and external audits.
- Monitored MDS completion and transmission, conducted clinical reviews, and analyzed reimbursement data.
- Assisted facilities with Case Mix audits and provided education to IDT staff.
- Served as a resource for residents, care teams, families, facility staff and payers.
- Managed reimbursement for various insurance plans and ensured MDS coding accuracy through clinical documentation systems.
- Communicated with the regional team and supported facilities during regulatory audits.
- Coordinated and completed resident assessments (MDS) in compliance with regulations.
- Collaborated with the Director of Rehab on assessment reference dates and tracked Skilled customers for compliance and non-skilled payors for optimal CMI.
- Ensured Medicare program requirements were met and participated in interdisciplinary team processes.
MDS Case Manager
Huebner Creek Health & Rehabilitation Center
07.2013 - 01.2019
- Coordinated and completed resident assessments (MDS) in compliance with regulations.
- Oversaw the MDS and resident care assessment process.
- Documented resident assessment data and maintained a quality assurance program for assessments and care plans.
- Served as a resource for residents, care teams, families, and payers.
- Collaborated with the Director of Rehab on assessment reference dates and tracked Skilled customers for eligibility.
- Gathered information for Managed Care Utilization Reviews and communicated with Managed Care organizations.
- Ensured Medicare program requirements were met and participated in interdisciplinary team processes.
- Ensured accurate and timely completion and submission of all MDS assessments, tracked default days, and performed assessment modifications.
MDS Case Manager
South Park Meadows Nursing and Rehab
07.2012 - 07.2013
- Documented resident assessment data and maintained a quality assurance program for assessments and care plans.
- Served as a resource for residents, care teams, families, and payers.
- Collaborated with the Director of Rehab on assessment reference dates and tracked non-skilled residents for optimization of CMI.
- Gathered information for Medicaid residents to optimize CMI.
- Ensured Medicaid program requirements were met and participated in interdisciplinary team processes.
- Ensured accurate and timely completion and submission of all MDS assessments, tracked default days, and performed assessment modifications.
MDS Case Manager
Brownsville Nursing And Rehabilitation Center
08.2006 - 07.2012
- Documented resident assessment data and maintained a quality assurance program for assessments and care plans.
- Served as a resource for residents, care teams, families, and payers.
- Created processes for residents and families to request care coordination.
- Collaborated with the Director of Rehab on assessment reference dates and tracked Skilled customers for eligibility.
- Gathered information for Managed Care Utilization Reviews and communicated with Managed Care organizations.
- Ensured Medicare program requirements were met and participated in interdisciplinary team processes.
- Ensured accurate and timely completion and submission of all MDS assessments, tracked default days, and performed assessment modifications.
Charge Nurse
Kingsville Nursing and Rehabilitation Center
08.2000 - 07.2006
- Obtain vital signs and assessments on resident.
- Administer medications to residents.
- Document any changes and status on residents.
- Coordinate care and changes with director of nurse, physician and families.
Education
LVN - LVN
Del Mar College
Corpus Christi, Tx08-2000
Skills
- Consistent reliability
- Effective organizational skills
- Clear communication
- Prioritization of tasks
- Managed care
- Medicaid
- Medicare
- Effective team collaboration
- Prioritization and scheduling
- Proficient in handling multiple tasks
- HIPAA compliance
- ICD-10 coding
Timeline
Regional Reimbursement Specialist
Creative Solutions in Healthcare
02.2019 - Current
MDS Case Manager
Huebner Creek Health & Rehabilitation Center
07.2013 - 01.2019
MDS Case Manager
South Park Meadows Nursing and Rehab
07.2012 - 07.2013
MDS Case Manager
Brownsville Nursing And Rehabilitation Center
08.2006 - 07.2012
Charge Nurse
Kingsville Nursing and Rehabilitation Center
08.2000 - 07.2006
LVN - LVN
Del Mar College
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