Rosa Maria Alemán. Email & Phone Number

Dallas, Tx, Us

United States

Performed site selection, initiation, monitoring and close-out visits, patient recruitment activities.Evaluated the quality and integrity of site practices in accordance with regulatoryrequirements, i.e., Good Clinical Practice (GCP) and International Conference onHarmonization (ICH) guidelines.

Dfw

-Worked on cases using a hybrid model of case management and utilization review, covering services for acute, inpatient, SNF (Skilled Nursing Facility), rehabilitation, long-term care, and palliative care, in accordance with Milliman guidelines.-Conducted pre-authorization and transition of care reviews following Milliman guidelines.-Reviewed prior approvals, network exceptions, benefit inquiries, inpatient medical/surgical admissions, and outpatient procedures for providers within a retail line of business.-Proactively managed the logistics of the patient's complex process of obtaining insurance approval for treatments such as infusions through collaboration with insurers, advocacy, and problem-solving, while navigating the infusion therapy process and insurance coverage.-Assessed and evaluated the efficiency and appropriateness of services for medical necessity by interpreting and reviewing evidence-based criteria, clinical guidelines, corporate policies, and mandates and standards.-Made decisions regarding the approval or denial of care, focusing on the quality of care and cost-effectiveness, using evidence-based data to support cost containment measures.-Utilized various business and clinical platforms (including IT, EHR, claims, case management, pharmacy vendor management, and quality measures databases) to track trends related to ER admissions, condition incidence and prevalence, and levels of care utilization. Reported findings in meetings, site visits, and requests for proposals.

Dallas/Fort Worth Area

• Provided patient care working for endocrinology, immunology, rheumatologist subspecialty, neurology outpatient care.-Supported the pre-authorization process by collecting and submitting required medical documentation, provided clinical justifications for the requested services, and acted as a liaison between healthcare providers and insurance payers. Followed up on requests, managed denials, assisted with appeals, educated patients and providers, ensured that the pre-authorization process was completed efficiently to avoid delays in care.

Dallas/Fort Worth Area

• Provided prenatal nursing care to complex, high-risk pregnancies, including geneticconditions, to prevent complications.• Supported care of research participants in an outpatient high-risk pregnancy referralcenter, ensuring adherence to regulatory standards and reporting at ParklandHospital.

Dallas/Fort Worth Area

Assessed patient education needs according to health condition, health literacy,readability, cultural education needs, education delivery method. Utilizedmotivational interviewing techniques to help patients set realistic health goals andencourage behavior change. •Utilized motivational interviewing techniques to help patients set realistic healthgoals and encourage behavior change.•Created tailored educational material written, bilingual, translated to Spanish,digital, and visual materials (brochures, videos, infographics) that explain complexmedical concepts in a way that is easy to understand, ensured patient material wasculturally sensitive, and appropriate for the patient's age, literacy level, andpreferred learning style.•Delivered Education in One-on-One during patient visits, explaining the diagnosis,treatment options, and self-care instructions. Group Education to communitygroups such as churches, schools and clinics as sessions or workshops on topics likechronic disease management, medication adherence, nutrition, and preventivehealth practices, and access to health care.• Acted as speaker in large community conferences.Acted as Member of the Hospital Patient Education Committee reviewing hundredsof patient education materials, filtering and discarding not appropriate materials.Participated in the review and approval of hospital approved material.•Established partnerships with local and state health organizations involved inpopulation health interventions directed to decrease disease burden in underservedpopulations.

Honduras, Central America

● Diagnosed and treated a wide range of acute and chronic conditions and field injuries.Worked with medical data including medical histories, laboratory results, medication reconciliation. Developed treatment plans and performed therapeutic procedures.

Associate Degree Nursing, Registered Nursing/Registered Nurse

Doctor Of Medicine (M.D.)

Devoted my practice to providing primary care services to a defined population of patients. Colaborated with public health systems.