angel nunez

Intake requests from plan members for expedited grievances and appeals. Created requests using various programs and built summaries including appeal request information, medical history, and diagnosis to determine if requests met expedite criteria in a fast-paced environment.

Coordinated care for patients under the chronic care management program, collaborating with providers to stay updated on patient care and chronic conditions. Initiated monthly calls to patients, assisting with health needs, resources, appointment scheduling, and educating on interventions and precautions.

Reviewed prior authorizations for various referrals including office visits, surgery, lab work, and medication requests. Utilized guidelines such as MCG to research medical history and diagnosis to determine if referrals met approval criteria. Possessed general knowledge of ICD-9 codes and health insurance plans.

Administered medications, performed treatments, and scheduled medical visits for residents, coordinating services with residents, pharmacies, and physicians. Documented and maintained accurate medication and care records, performing physical/mental assessments and monitoring. Assessed resident changes in condition or injury and initiated emergency care as needed.

Supervised med techs and caregiving staff, communicating with physicians regarding changes in condition, incidents, medications, labs, and treatment orders. Responsible for decisions on emergency services, administering medications and oxygen, and performing resident physical and mental assessments.

Assisted in developing and leading activity programs and events for residents, including those confined to their rooms. Greeted new residents, making special efforts to include them in activities and introduce them to others with similar interests and backgrounds.

Provided assistance with patient mobility, personal care, and maintained records of patient care, condition, and progress. Administered prescribed oral medications under physician direction and performed basic patient care services like changing linens.

Obtained a Licensed Vocational Nurse Certification, demonstrating proficiency in patient care and medical procedures. This certification equipped me with the necessary skills for various healthcare settings.

Completed general education courses, building a foundational academic background. These studies provided a broad understanding across various subjects.

Graduated with a high school diploma, completing foundational studies. This achievement marked the completion of secondary education.