Yamila Isales-Robles

• Led initiatives to optimize operational workflows, improving efficiency and reducing turnaround times.
• Collaborated with cross-functional teams to implement strategic process enhancements aligned with organizational goals.
• Developed training materials and conducted workshops to elevate team performance and knowledge retention.
• Analyzed data trends to identify areas for improvement, driving informed decision-making across departments.
• Facilitated stakeholder meetings to gather requirements and align project outcomes with business objectives.
• Spearheaded the integration of advanced analytics tools, streamlining reporting processes for enhanced visibility.
• Oversaw change management efforts, ensuring smooth transitions while minimizing disruptions to operations.
• Managed multiple projects simultaneously, prioritizing tasks effectively to meet deadlines and exceed expectations.
• Established a reputation for excellence in consulting services, consistently receiving positive feedback from both clients and colleagues.
• Conducted comprehensive analyses of client data to inform strategic recommendations and optimize business outcomes.
• Improved client satisfaction by delivering tailored consulting services and recommending best practices for their operations.
• Developed strong professional relationships with clients, fostering trust and driving long-term business engagements.
• Reduced operational costs for clients, identifying areas of inefficiency and recommending cost-saving measures.
• Streamlined internal processes for increased efficiency, implementing new strategies and tools within the practice.
• Evaluated the effectiveness of implemented strategies through regular follow-ups with clients, refining recommendations as needed.
• Collaborated with cross-functional teams to deliver high-quality solutions, ensuring consistent alignment with project goals.
• Delivered engaging presentations for clients detailing findings and recommendations, promoting clear communication and understanding.
• Ensured successful project completion by closely monitoring progress against milestones, adjusting plans when necessary.
• Increased overall productivity by optimizing workflows within client organizations based on thorough assessments.

• Served as the clinical point of contact for 125 provider practices across

Texas (Houston, Jefferson, and DFW) SDAs by facilitating bi-directional communications with our internal care management teams.

• Collaborated with the provider staff and Amerigroup Practice Consultant to create appropriate clinical intervention programs based upon the clinical complexities of the members assigned to their practice.

• Provided clinical guidance and direction to Amerigroup Case

Management teams to execute on identified programs and support

provider outreach.

• Acted as a resource for participating Physician Practices by assisting in the reduction of missed HEDIS Opportunities and increase Pay for Quality Incentives for their practice.

• Educated providers and their clinical/billing staff on HEDIS quality measure technical specifications, compliant medical record documentation, accurate billing code recommendations, and best practices.

• Abstracted charts via electronic medical records or paper documentation to validate claims data accuracy and ensure compliance with HEDIS measure criteria.

• Communicated significant findings, including potential risk management issues, to member advocates, quality management, provider relations, and risk adjustment teams utilizing Sales Force, Outlook, or Share Point reporting.

• Successfully advocated for patients annually, securing necessary medical treatments and resources by coordination with healthcare providers, and community resources.
• Arranged medical equipment for members discharged from the hospital to home, assisted care facilities or skilled nurse facilities.

• Oversaw administration of medications and monitored ventilation settings to ensure patient safety. Delivered wound care and implemented treatments in alignment with pediatric care plans.
• Performed continuous monitoring of vital signs to ensure optimal patient health and safety.
• Provided guidance to families on effective home care procedures to enhance child health management.
• Coordinated efforts with diverse teams to enhance the delivery of comprehensive care services.
• Maintained accurate records of patient progress to uphold compliance with healthcare regulations.
• Addressed patient and family concerns promptly, ensuring access to expert information on pediatric health.
• Ensured patient safety by rigorously following infection control protocols and sustaining a clean, organized treatment environment.
• Implemented strategies for effective management of pediatric cases at home, aiming to reduce hospital readmissions.
• Maintained accurate records of patient progress through detailed documentation and reporting during each visit.
• Supported families in effectively managing healthcare system navigation and insurance processes, ensuring clarity and ease during difficult periods.
• Administered specialized nursing care tailored to the unique needs of medically fragile children in their residences.
• Educated families on effective disease management techniques, promoting proactive involvement in their child's health.
• Assessed individual family needs and delivered customized support and resources to foster emotional well-being.