MICHAEL JAMES B. MERCADO

26+ Years of Professional Insight dedicated to a 'Person-over-Patient' Biopsychosocial approach. Leveraging a deep foundation in Inpatient and Outpatient PT (Philippines) combined with 14+ years of US-based practice in SNF, Home Health, and Hospice settings. Work rooted in a career-long philosophy emphasizing the substance of Human Connection, treating our care recipients as human beings rather than just 'cases' or 'medical ID numbers'. Value and practice the principle of Compassion Over Routine—true healing requires caring for the whole person with empathy, humor, and dignity, rather than just treating a 'patient' or 'diagnosis'. Intentionally harness humor as a caregiving tool to build rapport, ease tension, and bring joy, maintaining humanity in complex clinical and administrative environments.

CORE COMPETENCIES

• Possess a comprehensive functional knowledge of Kaiser Permanente’s Administrative and Operations lifecycle. While primary background is clinical, offer a deep-rooted understanding of the Revenue Cycle (Admin) and Continuum of Care (Ops) workflows, ensuring a streamlined transition from patient intake to final discharge.
• Highly proficient in the logic of Episode Management and CMS/Medicare guidelines. Serve as a strategic bridge between direct clinical care and back-office accuracy, ensuring that all operational processes maintain strict, audit-ready compliance.
• Adept at performing front-line Clinical Documentation Integrity (CDI) and Quality Assurance (QA) functions. Leverage deep knowledge of the OASIS data set to ensure every entry meets "Medical Necessity" standards, supporting both Value-Based Purchasing (HHVBP) logic and Outcome-Based Quality Improvement (OBQI) to proactively support the billing lifecycle and prevent re-hospitalizations.
• Holistic Case Management & Operations (Last 10+ Years): Highly proficient in bridging the gap between clinical care and administrative operations within Home Health and Hospice settings. Expert in aligning patient care plans with operational resource allocation and regulatory requirements to ensure seamless, compliant service delivery.

• Status: Priority Reassignment Candidate (Job Reassignment Program)
• Seniority: Approaching 11 years of tenure as a Home Health & Hospice PT Case Manager
• Accommodation: New Management Chain Necessity (Established 2025-12-03)

• Primary Hubs: Roseville (Eureka Rd/Riverside/Lincoln), Sacramento (DOCO/Rancho Cordova), South Sac (Bruceville Rd)
• Exclusions: Arden Annex strictly excluded
• Clinical Targets:

     •Priority Level 1 (Equally Preferred): Inpatient Acute Care Physical Therapist, Comprehensive Pain Management (CPMP) Physical Therapist, and Occupational Medicine Physical Therapist

     •Priority Level 2: Sports Medicine/Rehab Physical Therapist

     •Priority Level 3: Specialized PT Roles (e.g., Palliative Care, Neuro - Stroke Rehab)

     •Priority Level 4: Outpatient Physical Therapist

• Administrative Targets:

     •Priority Level 1: CDI (Clinical Documentation) – Clinical Documentation Practitioner, Senior Clinical Documentation Specialist, Clinical Documentation Integrity Specialist (CDIS), Clinical Documentation Analyst

     •Priority Level 2: UM (Utilization Management) – Utilization Management Clinician/Specialist, UM Specialist, UM Coordinator/Representative

     •Priority Level 3: Remote/Virtual Specialist Roles in Clinical Review, CDI, and Utilization Management

     •Priority Level 4: SME Roles (Subject Matter Expert) – Physical Therapy Quality Review Specialist (QRS) and Rehabilitative Therapy Utilization Coordinator (RTUC)

     •Priority Level 5: QA (Quality Assurance) – Senior Quality & Regulatory Specialist, QA Specialist, Regulatory Compliance Specialist, Quality Coordinator

     •Priority Level 6: PI (Performance Improvement) – Senior Performance Improvement Specialist, Clinical Quality Improvement Specialist, PI Specialist, Quality Improvement Analyst

     •Priority Level 7: Hybrid Roles (QAUM/QAPI) – UM & Quality Specialist, Quality & Performance Coordinator

     •Priority Level 8: Intake Roles – Case Management Coordinator, Clinical Intake Coordinator, Senior Patient Access Coordinator