Download Quality-Management-Resume

Ernesto Sandoval Llaneza III, BSN, R.N.
Graduated as a Dean’s Lister with two Bronze medals for Clinical service and Clinical efficiency
Registered Nurse of New York State
Member: AAMCN (American Association of Managed Care Nurses), NAHQ (National
Association for Healthcare Quality), ANA (American Nurses Association) and ANNA
(American Nephrology Nurses Association)
City Address: 300 Cedarhurst Ave APT H8, Cedarhurst New York 11516
Mobile Number: 516-395-6258 / 516-232-1426
E-mail: [email protected]
Summary of Qualifications
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Harlem Hospital Quality Management from 2014 to Present. Knowledge with
CMS, The Joint Commission Standards, Infection Control, Patient Safety and
Performance Improvement.
Charge Nurse Long Term care; Wound care nurse, Develops and oversees the
progress of the patient’s plan of care
Utilizations Review in Worker’s Compensation Official Disability Guidelines (3Years).
Quality Audit in the In-Patient Care Coordinator Department (Knowledge in
LEAN/SIX SIGMA)
Charge Nurse Dialysis Unit; Supervises staff and Patient treatment. Develops the
(CIPA) Comprehensive Interdisciplinary Patient Assessment Care plan and oversees the
patient’s progress
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Experienced Nurse in the ER /Medical/Surgical
Professional Experience:
Harlem Hospital Center Dec 1, 2014 to present
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CMS Measures, HANYS/IPRO Severe Sepsis and Septic Shock patient case Audits.
Quality Indicators for the board report.
Accountable Care Organization (ACO) measures.
Provides audit reports for medicine, labor and delivery departments.
Provides reports for infection control and prevention.
Provides reviews for Risk Management
Segundo Ruiz Belvis: Quality Management; Bronx New York (Under Onward
Healthcare Agency) August 2014 to Dec 1, 2014
Chart Reviewer:
 Conducts Medical Chart review/Audits for Quality achievement, performance
improvement for Patient care needs and The Hedis Quarr Reports.
 Reviews Physician documentation using the Adult Medicine Review Tool for evaluation
of the services received by the Patient.
 Reviews and analyses Quality Indicators for evaluation and furnishing of the quarterly
board reports.
 Formulates utilization reports for PCMH (Patient Centered Medical Homes) and ACO
(Accountable Care Organization) for anticipation of the needs of the Patient and the
enhancement of healthcare services offered.
 Works and contributes to the following committees ACO, PCMH, PI (Performance
Improvement) and Infection Control.
Rockaway Dialysis; Multiviz Health Management Corporation
Dialysis Charge Nurse February 2014 to Aug 2014
 Coordinates care with the hospital/Nursing home/Physician/for the Patients treatments.
 Supervises staff and patient care during dialysis treatments.
 Develops the (CIPA) Comprehensive Interdisciplinary Patient Assessment Care plan
and oversees the patient’s progress which involves the Physician, Dietician, Social
worker, laboratory results and the patient’s family.
 Documents and ensures doctor’s orders are transcribed clearly, timely and accurately
when it was given and collaborates changes in the patient’s status.
 Monitors the progress of patients by reviewing dialysis adequacy, anemia, management,
comorbidities and other significant medical information.
Winthrop University Hospital June 2013 to September 2013
Staff Nurse: Post-Surgical Unit
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Nursing assessments to Post-operative Patients
Skin and Wound assessments and treatment
Intravenous and oral medication administration
Coordination with physicians and other medical disciplines
Part time Home care Nurse MJHS November-December 2013
Sentosa services- New Surfside Nursing Home
Charge Nurse /Wound care/Medication Nurse New Haven Avenue, New York
May 2012 to June 2013
 Develops and oversees the progress of the patient’s plan of care depending on the
patients’ needs and continuity of care.
 Oversees the unit’s implementation of its care plan and protocols with coordination with
the multidisciplinary team (Physicians, Physical therapists, Dietician and other health
facilities).
 Supervises LPN’s and CNA in the implementation of direct nursing care, infection
control, safety precautions and patient’s ADL’s.
 Provides treatment such as wound care, tracheostomy care, pain management and
controlled medication monitoring.
UNITED HEALTH GROUP –Quality Analyst IN-PATIENT CARE COORDINATOR August
2011 to April 2012
 Supervises staff in following protocol in doing inpatient review for managing scheduled
admissions, and referrals to the disease management and referrals to skilled nursing
and acute rehabilitation.
 Reviews random communication made by staff to the field case manager and authorized
departments in the facility for accuracy and efficiency.
 Coordinates claims and referrals to specialists and other healthcare functions using the
Blended Census Report (BCRT)
 Monitors admission and discharge notifications and coordinates with Inpatient Care
Managers (ICMs)
Medical/Surgical Nurse May 2010-Aug 2011
 NATIONAL KIDNEY AND TRANSPLANT INSTITUTE (Philippines)Specialized
in Post-Transplant and Medical Surgical Nursing May 2010 to Aug 2011.Earned the
first Gantimpala award for delivering exceptional service and making a difference
inpatient care (March 2011)
 Provides nursing care to patients with chronic kidney disease, kidney failure and to
those undergoing an organ transplant.
 Responsible for preparing the patient before the operation, assisting and caring for
the patient after wards.
 After the operation, constant monitoring of the patients vital signs, their heart rate,
checking for possible organ rejection by the patient’s body, administer medicine to
reduce pain and inform the patient of the results of the transplant operation.
MEDICALL PHILIPPINES INCORPORATED
URAC Accredited Health Utilization Management (International)
Quality Assurance Award of Excellence June 2008
Position: WORKER’S COMPENSATION / UTILIZATIONS REVIEW
March 2007-May 2010
 Assesses and monitors documentation of clinical compliance and accuracy.
 Review medical records/abstracts from scanned documents of medical facilities.
 Reviews treatment (such as Pain Management, Narcotic usage and Physical Therapy)
and obtain clinical notes to determine if it is medically appropriate using ODG (Official
Disability Guidelines) and official State guidelines.
 Determination of the appropriateness of Surgeries, narcotics, various therapies and other
Post-Operative measures in coordination with the medical adjuster.
JONES MEDICARE COMMUNITY HOSPITAL, ISABELA, PHILIPPINES
ER/Medical Surgical Unit/ Community Health Nurse January 2006 to March 2007
 Prepares and administers medications and treatments as prescribed by physicians.
 Direct care provider, health educator, counselor and coordinator of health services for
the promotion of health, prevention of illnesses and crisis management.
Other work experience:
 Equitable PCI Bank: Branch accountant 1999 to 2002
 Standard Chartered Bank: Corporate Banking 2002
Education
1. Bachelor of Science in Nursing De Los Santos-STI College of Health
Professions, Inc. E.Rodriguez Quezon City November 2002 to October 2005
2. Computer Programming and Systems Design (Diploma Course 2yrs.); AMA
Computer Learning Center, Pantranco cor. Roces Ave. June 15, 2000 to
May 10, 2002
3. BCS Business Management and Entrepreneurship; San Beda College,
Mendiola St., Sanmiguel, Manila; June 1995 to May 1999.
Trainings
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Wound Care Nurse Certification Program, Wound Educators.com November
2013-December 2013
Dialysis4Careers Hempstead NY January 2014 to Feb 2014
MDS 3.0 & Strategies to Successful RUG III-53 and RUG IV -66: Duran
Consulting Services, INC Oct 4-5 2014
References
To be furnished upon request