RUBY GUZMAN
El Paso
Summary
Goal-oriented Manager dedicated to continuous improvement and driving positive business impact. Talented problem-solver and leader with high-level business and financial acumen. Motivates teams to reach performance goals and business objectives.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Director
WellMed Medical Management
05.2022 - Current
- Participate, provide, input, and impacts outcomes of Medical Management Committee, Market Success, Care Coordination, Market Patient Care Coordination, and Tier 1 Provider.
- Plan and implement assigned market and regional market success initiatives with each market care management and operations teams: Overall healthcare costs PMPM, Quality of Care Metrics, Acute patient care episodes through admits/k, readmits %, and ER Visits/k.
- Direct, plan, and Supervise activities for assigned team/region in an efficient and effective manner utilizing time management skills to facilitate the total work process.
- Provide effective problem-solving work as a care management liaison and resource with all customers internal and external to provide optimal customer satisfaction.
- Participate in the development, planning, and execution of continual process improvement efforts, policies and procedures, and regulatory compliance functions related to care management activities.
- Regional budget management, staffing, evaluations, performance reviews, Coaching for Success, interdisciplinary activities.
- Coordinate duties with appropriate personnel to meet operational program needs, ensures compliance with federal health plan requirements, Medicare guidelines, and NCQA standards.
Manager
WellMed Medical Management
05.2019 - 05.2022
- To Provide the best care to patients to the best of my abilities and stay within my scope of practice
- Monitored employee work to assess performance and identify knowledge gaps.
- Managers oversee a staff of case managers responsible for patient care coordination
- Case Manager evaluates to ensure that care is being provided in accordance with clinical guidelines and organizational standards
- In addition, Care Manager assists with development and improvement of clinical care pathways that enhance cost effectiveness while providing quality of care
- Coordination with other departments to collaborate new processes to improve efficiency.
Inpatient Case Manager
WellMed Medical Management
08.2017 - 05.2019
- In-Patient Care 'conducts initial assessments within designated timeframes on patients identified as having complex needs
- Collaborates effectively with integrated care team to establish care plans for patients
- Communicates with the care team that includes physicians, case managers, referral coordinators, social workers, and palliative care
- Utilization Management: Perform compressive assessments and document findings in a concise/compressive manner that is compliant with Center for Medicare and Medicaid Services
Hospice Registered Nurse Case Manager
Hospice of El Paso
04.2015 - 12.2015
- Hospice, Admissions- The Admissions Nurse is responsible for admitting patients/families to hospice in a timely manner upon patient/family and referral source request
- The Admissions Nurse conducts the intake and completes the admission process in a manner that promotes an interdisciplinary team approach to care, respects patients/families, meets Medicare/Medicaid conditions of participation and accreditation requirements and reflects the mission and philosophy
- The Admissions Nurse is also responsible for education and promotion of the hospice concept and the benefits of program and services to physicians, discharge planners, case managers and other internal and external healthcare professionals
Hospice Registered Nurse Case Manager
Gentiva Hospice
04.2015 - 12.2015
- Hospice, Admissions- The Admissions Nurse is responsible for admitting patients/families to hospice in a timely manner upon patient/family and referral source request
- The Admissions Nurse conducts the intake and completes the admission process in a manner that promotes an interdisciplinary team approach to care, respects patients/families, meets Medicare/Medicaid conditions of participation and accreditation requirements and reflects the mission and philosophy
- The Admissions Nurse is also responsible for education and promotion of the hospice concept and the benefits of program and services to physicians, discharge planners, case managers and other internal and external healthcare professionals
- The Admissions Nurse is responsible for admitting patients/families to hospice in a timely manner upon patient/family and referral source request
Registered Nurse Supervisor
Outreach Health Services
08.2010 - 04.2015
- Responsible for performing Quarterly Nursing Assessments for Star-Plus client
- Responsible for in home orientation/training of Personal Care Assistants
- Performs all Supervisory visits in accordance with scheduled frequency
- Performs all Initial visits and post-hospital visits as assigned
- Completes Star-Plus purchase request form and submits to Care Coordinator
- Responsible for signing all required Star-Plus forms for purchases derived from RN assessment.
RN Floor Nurse / Relief Charge
Highlands Regional Rehabilitation Hospital
08.2002 - 12.2010
- Responsible for ensuring excellent patient satisfaction and positive outcomes by supervising the care, treatment and services provided to patients by nursing staff on the Rehab unit and throughout the shift
- Supporting the efforts of the nursing staff by providing direct patient care when needed
- Assessing and reassessing patients throughout the shift and reporting patient concerns and changes in condition to the physician in a timely manner
- Participating on the interdisciplinary team by providing the appropriate information to the team, and utilizing the information received to ensure positive patient outcomes
- Creating a plan of care that is individualized to patient needs and is reflective of patient goals.
RN Floor Nurse / Post Partum
Del Sol Medical Center
01.2008 - 12.2008
- Managed direct care of patients, conducted assessments, and documented care activities.
- Administered oral, IV, and intramuscular medications as part of patient treatments.
- Developed and implemented treatment plans for patients with various acute and chronic concerns.
- Administered medications to patients and monitor patients for reactions or side effects to quickly intervene in serious issues.
LVN Floor Nurse
New Born, Thomason General Hospital, UMC
01.2001 - 01.2002
- Monitored patient health and administered basic care.
- Administered and medication and documented dosages and times
- Observed patients, recorded significant conditions and reactions, and notified nursing supervisor of changes and concerns.
- Observed patients, recorded significant conditions and reactions, and notified nursing supervisor of changes and concerns.
Education
Certified Case Manager, CCM -
12.2020
Bachelors Science - undefined
University of Texas
01.2016
Associate Degree - undefined
El Paso Community College
08.2006
Skills
- Employee training
- Performance management
- Team leadership
- New business expansion
- Health Plan Audits
- Policy implementation
- Task delegation
- Resource utilization
- Utilization management
Certification
Certified Case Manager
References
REFERENCES AVAILABLE UPON REQUEST
Languages
English
Full Professional
Spanish
Professional Working
Timeline
Director
WellMed Medical Management
05.2022 - Current
Manager
WellMed Medical Management
05.2019 - 05.2022
Inpatient Case Manager
WellMed Medical Management
08.2017 - 05.2019
Hospice Registered Nurse Case Manager
Hospice of El Paso
04.2015 - 12.2015
Hospice Registered Nurse Case Manager
Gentiva Hospice
04.2015 - 12.2015
Registered Nurse Supervisor
Outreach Health Services
08.2010 - 04.2015
RN Floor Nurse / Post Partum
Del Sol Medical Center
01.2008 - 12.2008
RN Floor Nurse / Relief Charge
Highlands Regional Rehabilitation Hospital
08.2002 - 12.2010
LVN Floor Nurse
New Born, Thomason General Hospital, UMC
01.2001 - 01.2002
Bachelors Science - undefined
University of Texas
Associate Degree - undefined
El Paso Community College
Certified Case Manager, CCM -
Similar Profiles
Georgia AlburyGeorgia Albury
Patient Care Coordinator at Wellmed at Flamingo / Wellmed Medical ManagementPatient Care Coordinator at Wellmed at Flamingo / Wellmed Medical Management
Karla AmayaKarla Amaya
Medical Assistant at WellMed Medical Management - United Health GroupMedical Assistant at WellMed Medical Management - United Health Group
LORANA HASETTELORANA HASETTE
Physician Business Manager at WellMed Medical Management - United Health GroupPhysician Business Manager at WellMed Medical Management - United Health Group
Sylvia LOPEZSylvia LOPEZ
Sterile Processing Technician at WellMed Medical Management - United Health GroupSterile Processing Technician at WellMed Medical Management - United Health Group
Abigail BarcenasAbigail Barcenas
Billing and Coding Associate at Quick Claimers Medical Billing and CredentialingBilling and Coding Associate at Quick Claimers Medical Billing and Credentialing