QUALITY CLINICAL COORDINATOR/HEALTH CARE RISK MANAGER
Accomplished and energetic Quality Clinical Coordinator with a solid
history of achievement in health care organization. Motivated leader with strong organizational and
prioritization abilities. Areas of expertise include risk management , case management , and quality
Extensive medical knowledge .Good judgment and decision-making abilities
Case management and risk management experiences
Problem solving skills
Familiar with all states and federal compliance regulations and standards
Strong interpersonal, organizational and customer services skills
Good verbal and written communication skills
Ability to work independently and as part of team
Medical Records review and audit experiences for Medicare Risk Adjustment (MRA) ,Healthcare Effectiveness Data and Information Set tools ( HEDIS) and STARS
Proficiency in planning, coordinating and implementing patient and staff procedures
Computer Skills: Microsoft Windows 10, Microsoft Excel 2016, Electronic Health Record Systems by Intergy, Nextgen, Citrix and Epic
Knowledge of ICD-9 and ICD-10
Quality Clinical Coordinator/Health Care Risk Manager May 2014 to June 2017HealthSpring- Cigna － Doral, FL
Conducts quality management studies according to criteria developed by the healthcare
organization, external review organizations and regulatory agencies( CMS, AHCA, AAAHC and NCQA)
Conducts provider site audits and medical record reviews to assess provider compliance with
state regulations and corporate policies.
Coordinate the processes involved in managing general liability and risk exposures for hospital or healthcare facility.Responsible for the oversight and direction of an organization's quality assurance programs, which involve peer reviews, patient care system enhancements, quality improvement initiatives and regulatory compliance
Quarterly Risk Management Report to Quality Management Committee
Annual Report and Evaluation to AHCA
Quality Improvement Coordinator/Healthcare Risk Manager March 2012 to May 2014HealthSpring of Florida － Miami, FL
Review patient medical records for monitoring and evaluation of quality and appropriateness
Abstracting data for outcomes databases, performing data analysis, conducting focus studies
and preparing reports for internal and external customers, including medical staff leaders.
Responsible for coordinating and supporting the organization and medical staff quality
improvement in a manner consistent with accreditation and regulatory standards.
Case Manager December 2009 to February 2012Doctor's Medical Center － Miami, FL
Determines clients' requirements by completing intake reviews, determining need for
therapeutic medical, psycho-social, and psychiatric evaluations; reviewing therapist
evaluations, treatment objectives, and plans.
Prepares clients' discharge by reviewing and amplifying discharge plans; coordinating
discharge and post-discharge requirements.
Manager, Medical Center November 2008 to November 2009Doctor's Medical Center － Miami, FL
Responsible for ensuring that health care facility provide the most effective patient care
Plan, coordinate, and supervise the functions of health care facilities and the staff .
Oversee billing and insurance filing
Supervisor healthcare regulations and follow up audits with CMS, AHCA, AAAHC and NCQA
Supervisor, Quality Control Department December 2004 to November 2008Doctor's Medical Center － Miami, FL
Setting daily, weekly, and monthly audit with the staff of quality control department
Organizing workflow by assigning responsibilities and preparing schedules
Overseeing and coaching employees
Check the daily report by the different departments
Submit reports on performance and progress
Train new employees on how to make medical record audit and final reports
Enforce healthcare guideline and company standards
General Practice Doctor July 1993 to October 1998Calixto Garcia Hospital － Havana, Cuba
Responding to medical / health problems presented by patients including history taking, diagnosis, investigation, treatment and referral as appropriate
Maintaining confidentiality and impartiality
Promoting health education in conjunction with other health professionals
Providing specialist clinics for specific conditions or for certain groups
Keeping up to date with medical development, new drugs, treatments and medication.
Education and Training
Health Care Administration, 2015Brookline College － Phoenix, AZ
Certificate and License : Health Care Risk Manager, 2014Agency of Health Care Administration － Tallahassee, FL
Health Services Administration, 2012Florida Career College － Hialeah, FL
Certificate : Notary Public, 2009Miami Dade College － Miami, FL
Certificate : Health Care Management, 2009McKesson Health Solution LLC － Miami, FL
Certificate : First Aid CPR AED, 2016Coast to Coast Medical Training － Miami, FL
Certificate : Lean Six Sigma Certified, 2017Management and Strategy Institute － Miami, FL
Medicine, 1993University of Havana － Havana, Havana, Cuba
Health Care Administration , 2015 Certificate and License : Health Care Risk Manager , 2014 Health Services Administration , 2012 Certificate : Notary Public , 2009 Certificate : Health Care Management , 2009 Certificate : First Aid CPR AED , 2016 Certificate : Lean Six Sigma Certified , 2017 Medicine , 1993
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