Daniela Valencia Email and Phone Number

Optimize processes to oversee the operations of projects and programs to ensure operational efficiency and coordinate with internal and external stakeholders. Work closely with HCP’s interdisciplinary clinical and non-clinical teams to create documentation to assist in maintaining an organizational database on established HCP methodologies. Along with creating graphic visuals for ongoing projects and initiatives and assisting in end-user support. In addition, ensuring that documentation practices and processes comply with applicable regulatory guidelines and requirements. Lastly, collaborating with the Business Systems Architect team to raise technical needs and requirements.

Design and develop written requirements, workflows, policies, and procedures relating to HealthCare Partners operational processes. Analyze business needs by capturing current workflows and identifying current business rules. In addition to identifying department workflow constraints by providing operational recommendations for enhancements.

Experienced professional with a proven track record in managing the operational impacts and workflow of the Nursing Home Transition Project. Responsible for overseeing a network of 200+ Nursing Home providers in the NYC, Nassau, Suffolk, and Westchester areas, ensuring their satisfaction and serving as their main point of contact. Act as a liaison between the plan and providers, resolving issues related to Medicaid enrollment, plan enrollment, and SNF authorizations. Proactively identify opportunities for provider education related to new state regulations on Nursing Home Transition. Collaborate with the Care Management Team to enhance provider and member satisfaction and organizational membership. Support the operations unit by verifying new and existing member data, conducting internal audits, and reconciling enrollment rosters. Possesses exceptional multitasking skills, problem-solving abilities, and a strong commitment to meeting critical deadlines. Proficient in utilizing MHS, MACESS, Trucare, and ePACES systems.

Dedicated professional providing support to Relationship Coordinator Supervisors and RN managers in generating accurate weekly reports for Senior Health Partners and Complete Care, ensuring the successful enrollment of potential members. Analyze projections on a daily and monthly basis to monitor appointment availability for future months. Deliver, assess, and assist with new hire and refresher training programs. Monitor daily schedules for nurses, ensuring precise logistics and systematics. Create coaching sessions and packages for both new hires and seasoned staff to successfully schedule RN visits. Serve as a liaison to troubleshoot issues by reaching out to prospects, Relationship Coordinators, and field staff. Collaborate with upper management to develop new workflows and job aids to enhance the scheduling process. Assist in training the new Scheduling Liaison for the reassessment team. Provide training to new staff on completing necessary reports, utilizing Excel, managing mailing lists, and scheduling in EMR and Outlook. Analyze daily reports and collaborate with supervisors to establish appropriate processes in compliance with internal systems, regulations, and directives.

Proactively interacted with potential members to evaluate their requirements for long-term care services. Conducted in-depth interviews with prospects to determine their eligibility for the organization's long-term care plans. Conducted thorough investigations and diligently followed up on Medicaid issues for existing members. Filed necessary complaints with the Appeal and Grievance Department when required. Regularly maintained and updated comprehensive weekly reports to ensure the delivery of high-quality care and drive continuous improvement. Skillfully coordinated field appointments for the Enrollment Team, catering to the needs of clients from Senior Health Partners, Healthfirst Complete Care, and Montefiore Diamond Care.

Proficiently utilized EMR, Excel, Microsoft Word, and Right fax on a daily basis to support various tasks and responsibilities. Efficiently triaged documents using the Sun Guard MACESS Module. Entered referrals and enrollment documents into the EMR database, ensuring accurate and up-to-date records. Demonstrated leadership as a team leader for RN Outsourcing Delta/SAAM data entries and RN Outsourcing Indexing into MACESS. Managed the processing and indexing of all withdrawal and ineligible letters.