Ernesto Báez Medina
Guaynabo
Summary
A Public Health Professional leading team members on-time job completion. Assign tasks, train employees, provide feedback, mediate interpersonal conflicts and implement company procedures. Excellent communication and listening skills. Provide leadership and vision which drives teams to meet goals.
Overview
16
16
years of professional experience
Work History
Health Management Programs Supervisor
Triple-S Salud
2017.07 - Current
- Execute, implement, and follow up on assigned tasks or projects to ensure the accomplishment of expected results.
- Elaborate work plans and reach established metrics for all business lines, complying with federal and local requirements.
- Responsible for interviewing, selecting, and training employees.
- Conduct staff evaluations and development plans. Establish performance standards that enable monitoring, evaluating, and developing the staff assigned. Identify areas for improvement and implement training activities.
- Responsible for preparing programs, assigning tasks, supervising workflow, reviewing expenses, and monitoring employees’ daily performances and activities.
- Monitors dashboard y assure metrics/timeframe are accomplish satisfactory within the timeframe establish by regulatory agencies.
- Develops indicators and processes for detecting, correcting, and preventing situations that have a negative impact.
- Develops updates, discusses, and presents the objectives in accordance with the organization annual strategic plan.
- Develops strategies to achieve Healthy People metrics in collaboration with other departments.
- Generate program reports including metrics trends and strategies with barriers identification.
- Documents and update the policies and procedures.
- Supervise and assure compliance with the annual work plan of the area, taking into consideration the needs of the business, usage reports, levels of quality indicators and emerging trends in the development of quality initiatives.
- Assist in the preparation, planning, and execution of the annual work plan of the Department.
- Monitor expenses through the year in conjunction with the Health Management Director and look for opportunities to implement cost saving actions.
- Works with delegated vendors to ensure compliance and performance.
Preventive Services Coordinator
Triple S Salud
2016.09 - 2017.07
- Develops, implement and monitor the Preventive Care Centers (PCC) for all the business lines and the EPSDT Model for the Government Health Plan.
- Ensures that each PCC and PMG meets its intended goals; identifies any barriers to the PCC and EPSDT development and proactively conceives of solutions to any problems that may hamper its implementation
- Provide follow-up to updated preventive services guidelines and regulations for the adult and pediatric population.
- Periodically visits the Primary Medical Groups (PMGs) and PCC to ensure providers satisfaction and compliance with preventive services requirements.
- Generate a work plan report per PMG or PCC and follow-up pending issues until its resolution.
- Coordinates the implementation of new PCC based in Triple S Preventive Service model.
- Responsible of monitoring the EPSDT model in the PMGs assuring its compliance.
- Request bi-annually the Gaps in Care report for the commercial line to de data analyst and distribute them to the PCCs.
- Establishes reports, and analyzes the indicators for evaluation and follow-up of all the contracted groups as required by the marketing department, in collaboration with and working under the Preventive Services Manager.
- Prepare a monthly report of the PCCs status, including statistics and common diagnoses, among others.
- Perform orientations to PCC, Triple S and PMG staff in the preventive service model.
- Organizes all the required activities for the fulfillment of the model’s quality assurance measures and projects.
- Updates the required documentation to ensure that preventive services comply with the federal and local regulations.
- Helps to define and implement places where the model can be improved by analyzing its performance.
- Analyzes the impact of the PCC and EPSDT model’s annual performance.
Customer Service and Provider Representative
Triple S Salud
2008.11 - 2016.09
- Provide in-person guidance on coverage, benefits, claims, among other information required by members.
- Perform contract process to new providers for Medicare through the credentialing application.
- Validate Providers contracts, credentials, and any information regarding of application process completion.
Education
Master Degree in Public Heath -
Ponce Health Sciences University
01.2016
Bachelor Degree, Airway Science Management -
Interamirican University of Puerto Rico
Bayamon Campus06.2007
Skills
- Computer Knowledge: Microsoft Office (Power Point, Excel, Word, Publisher, Outlook).
- Communication (Fluent in Spanish & English), strong organization, leadership, multiple tasking, empathy, responsible, organized, disciplined, goal directed, and motivated by new projects.
- Capability to work under pressure and analytical and assessment.
References
Upon request
Languages
Spanish
Native language
English
Advanced
C1
Timeline
Health Management Programs Supervisor
Triple-S Salud
2017.07 - Current
Preventive Services Coordinator
Triple S Salud
2016.09 - 2017.07
Customer Service and Provider Representative
Triple S Salud
2008.11 - 2016.09
Master Degree in Public Heath -
Ponce Health Sciences University
Bachelor Degree, Airway Science Management -
Interamirican University of Puerto Rico
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