Health Management Programs Supervisor - Triple-S Salud (Medical Insurance, Associate to the Blue Cross & Blue Shield Association) - Puerto Rico
(2011-01)
- Guide and supervised a multidisciplinary team and subcontract personnel team to comply with the Department goals.
- Supervise wellness program, prenatal care and chronic conditions programs, preventive services among others according to clinical guidelines, SDOH, and contractual requirements for all business line (Commercial, Medicare Advantage and Government Health Plan).
- Develop, review and implement policies and quality standards procedures.
- Evaluate Budget and vendors' proposals to create new contracts with the objective of expanding wellness offerings.
- Design, coordinate, and evaluate innovative clinical programs for client retention, compliance with screening tests and cost reduction in health services.
- Support CCIP Projects to comply with the requirements of each line of business.
- Supervise initiatives in variety of educational modalities such as virtual, telephonic, face-to-face interventions, through digital platforms, among others.
- Design and implement work plans based on needs, quality measures and closing gaps in care according Federal, Star Rating and HCIP stands.
- Monitored the timely performance of the employees in the workforce and motivated them to accomplish more.
- Train and support staff to handle constant changes according to business needs.
- Maintained and documented staff work and created monthly, quarterly and annual reports to the management about all lines of business.
- Maintain professional records updated.
- Conduct meetings with the sales team, clinical team, brokers, clients and prospects.
- Reviewing all educational materials for the different wellness initiatives and according to Unit needs.
- Evaluate and monitor the assigned budget to clinical equipment, subcontract personnel, special events, among others.
- Offer interventions on mass media communications (Radio, TV, Blogs, social media) about health topics and promotional campaigns of Triple-S.
Health Educator to MMM and PMC Population - MSO of Puerto Rico, INC (Medical Insurance) - Puerto Rico
(2010-01 - 2011-12)
- Clinical health education to elderly population.
- Develop and implement groups interventions to the Disease Management Programs according to CMS, NCQA and Star Program requirements.
- Design educational materials and publications for advanced age population.
- Created specific educational care plans for individuals' interventions.
- Coordinated screening clinics for educational activities and workshops.
- Coordinated Health Campaign and Preventive Services according to HEDIS measures.
- Develop and implement protocol intervention, process flow and strategies to Foot Care Project according CCIP requirements.
- Conducts risk assessments.
- Participated in round clinics with a multidisciplinary team.
- Prepare and submit daily, weekly and monthly reports.
Health Educator - Triple-S Salud (Medical Insurance, Associate to the Blue Cross & Blue Shield Association) - Puerto Rico
(2002-01 - 2010-12)
- Offer individuals and groups interventions as community needs.
- Coordinated and conducted educational activities of health promotion to the members.
- Organized health fairs.
- Administered questionnaires to the health customers.
- Implemented Manage Care Programs (Diabetes, Asthma, Hypertension and Congestive Heart Failure).
- Develop and Implemented Prenatal Care Program.
- Coordinated and promote behavior change programs such as smoking cessation and Weight Control.
- Assessments and development of work plans based on customers' needs.
- Marketing and Promotion of the different services and company products.
- Maintained working relationships with agencies and organizations interested in public health.
Health Educator - Integral Health Educational Program Inc (by Humana Medical Insurance) - Puerto Rico
(2000-01 - 2002-12)
- Coordinated Education and Prevention Services to members and community.
- Implemented Disease Management workshops.
- Design and offer Prenatal Care Programs.
- Promote and coordinate mammography clinics and other screenings to prevent cancer.
- Needs assessment and referrals to others health care professionals.
Health Educator - Early Head Start - Puerto Rico
(1999-01 - 2000-12)
- Planned and Direct Asthma Educational Program to parents and pre-school children
