Yolina Margulies

• Lead daily operations for Commercial Care Management teams, ensuring timely, member-centered care delivery that aligns with employer-group expectations and organizational ROI goals.
• Supervise and develop clinical staff through high-impact coaching and performance management, ensuring team-wide proficiency in Commercial-specific medical necessity guidelines.
• Drive process improvements in care transitions and discharge planning to prevent avoidable hospital readmissions and reduce unnecessary medical spending.
• Collaborate with interdisciplinary teams to identify barriers to care, ensuring patient-centered treatment plans meet both clinical needs and Commercial plan benefits.
• Monitor and audit care management functions (Assessment, Planning, Implementation) to ensure 100% adherence to NCQA standards and regulatory requirements

• Managed comprehensive medical and socio-economic service coordination for Medicare and Medicaid recipients within complex DSNP caseloads.
• Conducted holistic health assessments to evaluate member status, resource utilization, and prognosis, developing individualized care plans with specific clinical goals and interventions.
• Identified and mitigated barriers to care, facilitating access to community-based services, specialists, and medical providers to ensure a seamless continuum of care.
• Coordinated efforts with PCPs and non-medical personnel to enhance treatment plan alignment and contribute to integrated care management discussions.
• Optimized patient outcomes and cost-effectiveness by monitoring referrals, educating members on chronic condition management, and adjusting care plans based on real-time health data.
• Ensured compliance with all regulatory requirements while promoting high-quality, patient-centered care for high-risk populations.

• Administered comprehensive ESRD care while coordinating multiple treatment stations, prioritizing patient safety and treatment efficacy.

• Expert post-anesthesia care specialist with a strong background in stabilizing high-acuity surgical patients. Skilled in rapid assessment, airway management, and hemodynamic monitoring.

Leveraged extensive experience to assess and manage complex patient conditions in intensive care environments.