Mary Grace Celso, BSN, RN

Experience

• 

  Calamba Medical Center

  Jul 2006 - Dec 2006

  Registered Nurse

  Staff Nurse on Rotational duties in areas like: Intensive Care Unit (ICU), Medical - Surgical Ward and OB ward

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  Infonxx Inc

  Jan 2007 - Aug 2007

  Customer Service Specialist

  * Provided Enhanced Directory Assistance which includes Business and Residential listings * Real-Time Directions * Movie Times and Listing

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  Convergys Intelligent Contact

  Aug 2007 - Feb 2009

  Customer Care Representative - Tier 3

  - Ensure service delivered to customers by meeting contractual Key Performance Indicator (KPIs).- Clarify customer requirements; probe for understanding, use decision-support tools and resources to appropriately provide resolution to the customer.- Listened attentively to customer needs and concerns; demonstrate empathy while maximizing opportunity to build rapport with the customer.- Greet customers in a courteous, friendly, and professional manner using agreed upon procedures.- Maintain basic knowledge of client products and/or services including Troubleshooting technical issues and billing concerns- Participate in activities designed to improve customer satisfaction and business performance.- May offer additional products and/or services.Track, document and retrieve information in call tracking database. Show less

• 

  MediCall Philippines, Inc.

  Mar 2009 - Nov 2012

  - Identify training needs by evaluating strengths and weaknesses- Translate requirements into trainings that will groom employees for the next step of their career path- Build annual training program and prepare teaching plans related to Utilization Management, Workers Compensation, Medicare and Bill Review - Develop or oversee the production of classroom handouts, instructional materials, aids and manualsmanuals- Direct structured learning experiences and monitor their quality results- Acclimate new hires to the business and conduct orientation sessions- Deliver training courses for Utilization Management, Workers Compensation, Medicare and Bill Review- Assess training effectiveness to ensure incorporation of taught skills and techniques into employees work behavior- Periodically evaluate ongoing programs to ensure that they reflect any changes- Stay abreast of the new trends and tools in employee development Show less - Delivers training programs for new nurses and/or provide cross training of senior/veteran nurses transferred to another program.- Delivers Worker’s Compensation curriculum, Medical Bill Review Services and basics of Utilization Review and Utilization Management to the employees selected to be part of the program.- Instructs the step by step procedure on client system navigation to the new hire trainees and existing nurses.- Direct the nurse reviewers on how to determine the causal relationship of workerscompensation claims.- Audits and filter cases that are completed in the system before sending the claims to the adjudication department.- Direct the medical bill review specialists to use established guidelines, proceduresand policies created as per client protocol.- Reviews, analyzes, adjusts and releases medical bills upon return from Data Capture.- Index medical bills, reports and identify the correct claim number assigned.o Provides an excel file of Fee schedules, CPT, ICDs , HCPCS, POS, Bill type codes listing as reference by the medical bill review specialists and nurse reviewers. Show less The Utilization Management (UM) Intake Representative is responsible for supporting department staff, enrollees, and providers relating to Prior authorization requests and authorization reviews. The UM Intake Coordinator collects data and information to generate authorization references using Trusted policies and procedures. The Intake Coordinator demonstrates the Medical Management culture of compassion, integrity, innovation, intra- and interdepartmental collaboration, transparency, supports data-driven decisions, and remains performance driven.Main Roles and Responsibilities:- Appropriately handles and monitors authorization requests, inquiries and related information received via phones, faxes, emails, portals and other inbound and outbound communication devices in a timely manner.- Verifies enrollee eligibility for services before generating cases for review.- Determines and acts in accordance with the appropriate course of action based on pre-established guidelines and standard operating procedures.-Routes, redirects clinical correspondence to appropriate clinical team members. Show less

  • Senior Nurse Development Training Specialist - Clinical Training

    May 2010 - Nov 2012

  • Product Trainer, Non- Clinical Training Department

    Sept 2009 - May 2010

  • Fax Intake Representative

    Mar 2009 - Sept 2009
• 

  Cognizant

  Nov 2012 - Jul 2022

  Overseeing Training Delivery and Development:• Ensures delivery of end to end training curriculum to new hires: o Boot camp o Domain o Knowledge Transfer o Ramp/Nesting Period• Floor Support in Steady State• Coaching and Supervising Trainers based on expectations• Assists and Develops Training Logistics• Manages training attrition and capacity• Review, update and provide recommendation on training materials and modules• Creates and Develops Training Plan and Calendar• Reviews, documents and develop training reports, trackers and Dashboard• Conducts Recursive training based on Training Need Identification/Analysis received from Operations and QualityOverseeing Quality Execution• Single point of contact for Quality Support of Client Account(s)• Implementation of Quality Standards in the Account • Providing High Quality Business analytics support to Management team• Identifying improvement opportunities along with the respective SDLs and Process Head and facilitating launch of projects around these opportunities• Adherence to legal & regulatory requirements as applicable to the nature of work. • Adherence to Client Contractual Requirements and SLA • Monitor Compliance adherence and ensure a monthly review of status• Facilitate Regular Audits to detect any compliance or contractual breaches and encourage continuous improvements• Ensure Risk assessment is conducted for the process at the start of Operations and on any major change-taking place.Team Management• Capacity Planning and Execution• Review Key Performance of the team• Review Performance trends and provide Data Analysis on error trends such as Root Cause Analysis (RCA) and recommendation for CAPA (Corrective action and Preventive action Plans)• Provides Regular Coaching and Mentoring• Ensures regular calibration sessions across auditors Show less - Ensuring strategic alignment of the training department with business goals - Evaluating individual and organizational performance to ensure training is meeting business needs and improving performance - Identifying training needs by consulting with stakeholders and using needs assessments - Developing and delivering training solutions that meet business needs - Optimizing training processes for efficiency - Selecting and managing resources, including working with both internal employees and training vendors to develop and deliver training -Managing the technologies and technical personnel required to develop, manage and deliver training Show less Identify training needs by evaluating strengths and weaknesses- Translate requirements into trainings that will groom employees for the next step of their career path- Build annual training program and prepare teaching plans related to Utilization Management, Workers Compensation, Medicare and Bill Review - Develop or oversee the production of classroom handouts, instructional materials, aids and manualsmanuals- Direct structured learning experiences and monitor their quality results- Acclimate new hires to the business and conduct orientation sessions- Deliver training courses for Utilization Management, Workers Compensation, Medicare and Bill Review- Assess training effectiveness to ensure incorporation of taught skills and techniques into employees work behavior- Periodically evaluate ongoing programs to ensure that they reflect any changes- Stay abreast of the new trends and tools in employee development Show less

  • Service Delivery Manager - Clinical Training and Quality

    Jun 2021 - Jul 2022

  • Team Manager - Clinical Training and Quality

    Jan 2018 - Jun 2021

  • Team Manager - Clinical Training and Development

    Dec 2013 - Jan 2018

  • Team Leader - Clinical Training

    Nov 2012 - Dec 2013
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  UCI GROUP OF HEALTH CARE SERVICES, INC.

  Aug 2022 - Mar 2025

  Case Manager Home Health Nurse
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  Accessible Home Health Care

  Oct 2022 - now

  Registered Nurse
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  Pinnacle Home Care

  Nov 2024 - now

  Home Health Nurse