sterling virginia, US
Phone: xxx-xxx-xxxx
Email: xxx@xxxx.xxx
Looking For: heath care,
Occupation:
Degree: Professional Degree
Career Level: Fully Competent
Languages: English Spanish
Highlights:Certified Health Care Audit and Health management Professional with 15 years experience as a Career Specialist, Technical and medical operation regarding health and health products, EPS- IPS and Insurance Companies, with emphasis on process management., Service networks, health products and medical audit of structure, process and outcome, and evidence-based medical relevance. Practice on statistics public health, high cost disease management and action plans with measurement results from the same analysis and impact on health quality of life and reducing cost of diseases based in use in trigger tools and in early prevention of complications. Design and implementation on Risk management for High cost diseases and chronic patients. . Analytic and logical thinking, self-management capacity, ability to take on challenges; skills to lead, coordinate and execute projects, develop and evaluate research, Perform administrative and operational management, abstracting and model real problems, analyze and propose solutions based on the development of clinical strategies, technical or procedural; Ability to perform highly complex jobs quickly with specialists and interdisciplinary groups ; Skilled in managing quality assurance, design products and processes, human resource management, teamwork, commitment, proactive adaptation and change. Effective communicator with ability to create materials that convey value for both clients and end users.
Skills:
Goal:To secure a position with a well established organization with a stable environment that will lead to a lasting relationship in the field of Health Care Management, To obtain a position that will enable me to use my organizational skills, educational background, and ability to work well with people, and enables me to make a positive contribution to the organization.
Certification:Degree: PHYSICIAN AND GENERAL SURGEON Escuela de Medicina Juan N. Corpas: 01/1988 to 12/1994 (Six years) Degree: AUDIT HEALT SPECIALIST Colegio Mayor de Nuestra Señora del Rosario: 01/1996 to 12/1998 (Two years) Degree: HEALTH CARE MANAGEMENT AND ADMINISTRATION Corporacion Universitaria Iberoamericana: 01/1995 to 12/1996 (One year and a half)
Medical Director 08/2010 - current
HELPHARMA S A, Bogota, Colombia Colombia
Industry: HEALTH CARE
Risk Managment Models and High Cost Diseases Administration
Design, development, implementation and management of a Risk Management Model in high cost diseases for chronic patients, Design development, implementation and audit of clinical management guidelines specific to control and prevent complication in normal progress of chronic diseases patients with multiple an complex Comorbidities associating insurer's control, and management in order to change results in health. Design, development, implementation of a pharmacoeconomic model to measure the impact of health and disease management including Clinical research and investigation process and publications.--
High Cost Health Audit 12/2008 - 08/2010
EPS SURA, Medellin, Antioquia Colombia
Industry: Health care
Audit for High cost diseases , insurances management
High cost audit focused on catastrophic diseases and High cost treatments (Pharmacy, Dialysis, orphan diseases, High Cost Surgical procedures). It includes planning, design, implementation and management of clinical practice. Patient security management an Adverse Events--
Audith in Health department 08/2007 - 08/2008
EPS SURA, Medellin, Antioquia Colombia
Industry: Health Care
Audit in patient and out patient services, ER, Intensive Care units
Audit focused on primary care at Susalud IPSs at Medellin city, special programs home health services, management of results and health indicators review, definition of action plans with health care units, and clinical cases analysis.--
: Health Audit 03/2007 - 08/2007
Colmedica, Medellin, Antioquia Colombia
Industry: Health Care
Billing, Audit in and out patien services
Audit focused on primary care at Susalud IPSs at Medellin city, special programs home health services, management of results and health indicators review, definition of action plans with health care units, and clinical cases analysis.--
Health Care Coordinator 07/2006 - 03/2007
PREVIMEDIC S.A, Bogota, cundinamarca Colombia
Industry: Health care
Billing Authorization process, Higth cost diseases managment, medical centers administration
National Authorizations Process Management, High Cost diseases Coordination, Medical Network negotiation, management and administration of Medical Centers--
Director Medical Bills Department 05/2005 - 06/2006
HUMANA SA, Bogota, Cundinamarca Colombia
Industry: Health care
Billing, Audit, Authorization
Management process nationwide medical bills, , interaction with Medical department in order to plan renegotiation process for medical cost containment., Prepare the department, medical network and company bills for process for liquidation as company was sold--
Manager health care product 02/2004 - 03/2005
HONDURAS MEDICAL CENTER, Tegucigallpa, Tegucigalpa Honduras
Industry: Health care
Management, Insurance, Billing, Autorization Procecess
Management Hospital prepaid medicine Product. Definition, construction, maintenance of medical network. Authorization and medical bills process. Overall management technical, administrative, financial and commercial office prepaid plan Honduras Medical Center.--
Medical Network and Health Audit Department Coordinator 04/2001 - 01/2004
HUMANA S.A., Bogota, Cundinamarca Colombia
Industry: Helth Care
Fees negociation, Medical and Hospital Network management across the country
Negotiation of Medical services, relationship with providers, support for medical bills department, claims and complaints process, medical support area authorizations and medical department and audit department--
Medical Network and Health Audit Department Coordinator 04/2001 - 01/2004
HUMANA S.A., Bogota, Cundinamarca Colombia
Industry: Helth Care
Fees negociation, Medical and Hospital Network management across the country
Negotiation of Medical services, relationship with providers, support for medical bills department, claims and complaints process, medical support area authorizations and medical department and audit department--
National Medical Centers Director 03/1997 - 04/2001
COLSEGUROS, Bogota, Cundinamarca Colombia
Industry: Health care
Administration medical centres across country, and responsible Medical Cost data Analisis in heath products, Definition and action plans implementation to manage the Medical cost
Planning and management of basic medical units across the country, Including administrative, technical, and medical processes, Audit of medical care attention and quality standards, statistical analysis of medical cost and feasibility studies.--
General physician 01/1995 - 06/1996
MILITARY AIR FORCE BASE GASUR CACOM N.6, Florencia, Caqueta Colombia
Industry: Health Care
out in patien services
Medical assistance to civil and military group (army, navy and air force), recruitment process,
Assistance on Surgery first level of complexity
Medical attention to the local population and massive brigades of health at the region of Caquetá Colombia.--
Escuela de Medicina Juan N. Corpas 01/1988 - 12/1994
Bogota, Colombia, Colombia
Degree: Professional Degree
Major:PHYSICIAN AND GENERAL SURGEON
& years career
2 years as a practice in a national reference Hospital SAN PEDRO CLAVER
ANA MARIA ESTRADA RESUME