Utilization Management and Case Management
Elina Vergara, RN
Director of Utilization Management and Case Management for Illumina Medical Centers, Elina Vergara is a registered nurse who has 7 years experience within the healthcare field.
Elina launched her career at Medica Healthcare Plan where she created the chronic care initiative for cardiovascular disease. This program was put in place by Elina, that assisted all members who were diagnosed with cardiovascular conditions with health treatment alternatives to promote any lifestyle changes. Medica Healthcare plans was ultimately acquired by United Healthcare Plans where Elina led the transition team with articulacy to construct a stress-free changeover into a new organization.
Elina managed all monthly SNP Model of Care audits aside from conducting internal audits for her entire case management department. She was also the lead case manager for the Admission Prevention initiative, implemented the referral process, and supported the National Committee for Quality Assurance accreditation. In May of 2016 Elina participated in the CMS live walk though, in which, Medica Healthcare planned passed with straightforwardness. In addition, she also directed utilization by reducing ER visits, admissions, and readmissions.
In September 2017, Elina supported with the migration for the unveiling of the first South Florida Nurseline with United Healthcare and Optum Services. Here she headed a 24 hour, 7 days a week team that consisted of more than 20 clinicians across 4 different states. Elina established team directions, supervised all work activities by all staff members, and adapted departmental policies and procedures for Optum Services.
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