DIEGO SHMUELS MD,MPH,CHCQM

Experience

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  UNIVERSIDAD DEL ROSARIO

  Jan 1990 - Jan 1997

  DOCTOR IN MEDICINE AND SURGERY (MD)

  Medical School education and training

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  Health Department Cundinamarca

  Jun 1996 - Jun 1997

  MD Social Service

  Protocol implementation on chronic diseases, STD's and risk factors

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  CAFESALUD ESIMED

  Aug 1997 - May 1999

  FAMILY PRACTICE MEDICAL COORDINATOR

  • Overview management of Chronic Ill Patients with HIV, CANCER, DM, HTN• Qualify medical and clinical records from every physician on site.• Establish protocols for treating, educating and managing patients.• Establish diagnostic and screening tools for probable epidemic diseases.• Overview hospital treatments and referrals of chronic ill patients such as HIV and Cancer patients.• Epidemiology Report to the Health Department

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  SAN JOSE HOSPITAL/PARTHENON CLINIC

  Aug 1998 - May 1999

  EMERGENCY ROOM PHYSICIAN AND INSTRUCTOR

  Primary Responsibilities: Instruct interns and medical students.Coordinate acute management and Hospitalizations of patients; specially determine overextended stay of chronic ill patients.Referral of Psych patients to social services and determine function scale for ADL management, previous stabilization and crisis intervention management

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  UNIVERSITY OF MIAMI -Center for Family Studies

  Jan 2000 - Aug 2003

  Research Associate VI,

  Primary responsibilities provide neuro-psychiatric batteries for elders including developmental disabled adults non institutionalized and follow up of participants providing social services referrals and case management.Recruitment of clients for NIH, NIMH and NIDA studies and provide assessment protocolsIRB Compliant Supervisor Assistant.Aide in randomization of subjects for the needed studies. Maintained minimum federal standards for quarterly reviewQA of data entry and supervise interviews performed by other Research AssociatesInterview/counsel and application of protocols in the study. Show less

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  YMCA of Greater Miami

  Jan 2000 - Jun 2003

  Program Director

  Primary responsibility: Create programs for at risk youth and mentally disabled teens, adult programs for DM, OA, HTN and COPD patients or at risk to promote healthy lifestyles as YMCA standards.Provided different activities for mentally disabled teens, including after school care with mixed population of teens at risk and/or mentally disabled from all ethnicities and backgrounds.Review monthly progress and referral to social programs and rehabilitation.Grant writing.Recruitment of participants and of volunteers for the programs created.Overseeing support staff, hiring and training of staff.Budget development and quarterly report evaluation. Show less

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  CJ MEDICAL INC

  Aug 2003 - Nov 2008

  HIV SPECIALIST AND MEDICAL CONSULTANT

  • Educate and train office personnel of medical policies from Medicare, Medicaid and private insurances .• Audit charts, billing procedures if required by physicians.• Improvement of Standards of Care for practitioners, evaluated through different performance tools and as per CDC guidelines• Evaluate cost-effectiveness in their practice with improvement of quality attending HIV patients. • Evaluate data obtained by cross reference of labs and patients health to determine standards of care outcome and need to increase promotion and prevention • Educate practitioners providing resources to update and improve their knowledge on HIV and STD’s• Improve income for the company as well as increase clients willing to improve their standards of care with their patients and increase their auditing tools. Show less

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  Citrus Health Network

  Jun 2007 - Jan 2008

  Master Health Practitioner, Assessment Counselor

  Primary responsibility: Perform crisis interventions and psych evaluation at emergency room for patients and mentally disabled clients participating of the network.Triage, functional assessment scale and mini mental intake of clients.PRT backup in the housing department

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  INTERNAL MEDICINE MGMT COMPANY

  Nov 2007 - Dec 2008

  QUALITY ASSURANCE AND UTILIZATION DIRECTOR

  • Site audit of medical offices and physicians under our MSO.• Review utilization of participating physicians, evaluate adequate use of resources as well as improve their utilization.• Create tools to audit medical offices, chart supervision and compliance with ACHA and CMS• Improvement of quality and assure adequate service provided to our patients as well as manage relations with our different HMO providers and client relations• Evaluate data obtained from HMO and evaluate cost –effectiveness as observed by decreased hospitalizations, decreased morbid-mortality and improvement of quality of life.• Evaluate transcriptions, credentialing and billing procedures performed by our staff.• Provide in service training to enable physician’s offices to manage referrals, prescriptions as required per plan.• Provide educational resources to medical and administrative staff to increase knowledge of managed care in lieu of improving surplus income for the company Show less

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  ALPHA-1 FOUNDATION

  Aug 2009 - Jul 2011

  MANAGER OF PROGRAM ADMINISTRATION

  Managing the Florida Detection Program for Alpha-1 in conjunction with the Florida Department of Health, to increase awareness and education and to find a cure for such genetic condition.Enroll providers in the program as well as provide monthly and quarterly reports to the Board of Directors at the foundation as well to the Department of Health. Manage and evaluate Clinical Resource Centers partnering with the foundation all over the country. Provide positive outcomes for all programs with the Alpha-1 Foundation and evaluate them to improve standard of care an quality of such programs. Show less

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  BORINQUEN HEALTH CARE CENTERS

  Jun 2011 - now

  DIrector Quality Outcomes & Performance Improvement

  Management of: Quality Assurance Department, Accreditation and Audit preparedness. Quality Improvement programs including but not limited to the health plan, QI/QA plan, Uniform Data Surveillance,accreditation initiatives and Health Resources Service Administration (HRSA) grants. Co-chair of HIV Qual. Committee.Accomplished Level 3 PCMH (first in Florida) and AAAHC ambulatory care accreditation. • Facilitation, development, implementation and annual review of the BHCC Continuous Quality Improvement Program Plan (CQIP) by Identifying, assessing and monitoring quality improvement opportunities related to the provision of ambulatory health care services, by implementing strategies that follow the QI plan, government mandated programs such as “meaningful use”, and accomplishing “Medical Home” status with the collaborative effort of HCN.• Implementation of QI activities as a result of periodic medical and/or electronic health record reviews/audits including peer review audits and other related activities.• Collect and summarize performance improvement data and report findings and outcomes quarterly to the CQI Program Core Committee and BHCC Senior Management Team.• Collaborate with and represent BHCC with external agencies and organizations involved in quality and performance improvement programs and initiatives to enhance periodic training sessions with the BHCC Staff and Board of Directors on relevant quality improvement topics and subject matter• Facilitate the development of policies and procedures related to accreditation and related reassessment activities.• Implementation of Program Evaluation to improve outcomes of QI programs and projects. Show less

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  Borinquen Health Care Ctr

  Jun 2014 - now

  Responsible for implementing and managing the organization’s Quality and Performance Department, Risk Management, Clinical Practice Management and all clinical operations that support the Health Resources Service Administration (HRSA) grants and National Accreditation Status. Maintaining NCQA Medical Home recognition and AAAHC accreditation, which supports the mission of the organization.Currently the Designated Institutional Official for Borinquen's ACGME accreditation. • Development and supporting of the Organization’s Continuous Quality Improvement Program Plan (CQIP) in conjunction with the CMO by Identifying, assessing and monitoring quality improvement opportunities related to the provision of ambulatory health care services, results in maintenance of current accreditation efforts and supports the standard of care and performance of daily clinical operations at all sites. • Development and supporting of the Organization’s Clinical Operation’s Policies and Procedures for Quality Improvement including Risk Management, Infection Control, HIPAA and Nursing Policies • Implementation and oversight of all quality improvement, data management, and business processes that affect patient flow, service access and continuity of care to improve patient outcomes, revenue and decrease risk such as Pay for performance, HEDIS and incentive programs .• Implementation and Oversight of all Quality and Performance activities including but not limited to disease and population health management programs, risk management for over 32,000 patients and over 300 healthcare staff. Show less

  • Chief Quality Officer

    Nov 2018 - now

  • Director of Clinical Practice Management-Quality Outcomes and Performance Improvement

    Jun 2014 - now