Mirely De Jesus
Cayey
Summary
Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills. Strong problem-solving abilities and a proven track record of fostering strong relationships with clients and team members. Focused on supporting team success and achieving positive results.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Care Management Specialist
MCS
San Juan, PR
01.2024 - Current
- Evaluates the criteria for admission to Complex Care Management Program and Initiatives.
- Proactively identifies problems and barriers that may affect the policyholder enrolled in the Care Management program using their judgment and the clinical guidelines adopted by the Company.
- Complies with the Initiative and Special Projects aimed at achieving the Stars, compliance with the Model of Care, and Hedis mesuares.
- Perform the Organizational Determinations and Transitional Care process according to the regulatory agency’s established requirements and timelines for each line business, following the MOC, Operational Guidelines, and Policies and Procedures.
- Evaluates the effectiveness of the policyholders treatment. Takes part in cases discussion with Providers whenever required to reevaluate the care plan according of service nedded.
Clinical Nurse Leader
Cossma
Cidra, PR
02.2023 - 01.2024
- Served as a resource person for nursing staff providing guidance and support related to clinical issues.
- Implemented or evaluated standards of nursing practice in pediatrics, acute care and geriatrics.
- Developed and maintained departmental policies, procedures or patient care standards based on evidence-based practice guidelines or expert opinion.
- Collaborated with physicians and other healthcare professionals on best practices for patient care delivery.
- Reviewed medical records for accuracy, completeness and compliance with established regulations.
- Supervised hiring, training, and development of nursing and staff.
- Organized department in accordance with administrative guidelines to provide specified nursing services to meet legal, organizational, and medical staff guidelines.
- Implemented OSHA and biohazard safety training and prevention programs for staff.
- Utilized technology systems such as EMRs or electronic health records to document findings accurately.
Nurse Supervisor
Facilidades Medicas Asociadas / Redes de Salud
Humacao, PR
06.2014 - 07.2020
- Applied clinical judgment and comprehensive knowledge of facility policies to assist floor nurses with patient care decisions.
- Oriented, assessed and mentored staff on correct procedures and clinical skills.
- Tracked employee vacation, personal and sick leave earnings and use.
- Managed payroll and time and attendance systems.
- Prepared or maintained employment records using human resources management system software.
- Hired employees and processed hiring-related paperwork.
- Reviewed resumes, conducted phone screens, and managed candidate pipelines.
- Managed changes in integrated health care delivery systems and technological innovations while keeping focus on quality of care.
- Provided leadership in creating a positive work environment.
- Coordinated interdepartmental communication between medical staff, administration, and other healthcare providers.
Education
Bachelor of Science - Nursing
National University
Caguas06-2017
MBA - Health Care Administration
Universidad Ana G Mendez
GuraboSkills
- Follow-up care coordination
- Organization and time management
- Analytical
- Leadership
- Patient communication
- EMR management
- Regulatory compliance
- Adaptability and flexibility
- Organizational skills
- Project management
- Case management
- Policy development
- Excellent communication
- Problem-solving aptitude
- Task prioritization
- Decision-making
- Computer skills
- Critical thinking
Certification
- Registered Nurse
- CPR
Timeline
Care Management Specialist
MCS
01.2024 - Current
Clinical Nurse Leader
Cossma
02.2023 - 01.2024
Nurse Supervisor
Facilidades Medicas Asociadas / Redes de Salud
06.2014 - 07.2020
Bachelor of Science - Nursing
National University
MBA - Health Care Administration
Universidad Ana G Mendez