Monica Dantzler-Thomas
Director of Care Management Accreditation at URAC- Claim this Profile
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Bio
Courtney J.
It is a pleasure working with Monica. She is a teamplayer, hardworker, self- starter and a true leader! Monica does a great job being the Manager of Case Management and Quality. She is an asset to any organization!
JB Brown (The Aflac Guy)
Monica is a detailed and professional manager. Her ability to finish assignments and multi-task is paramount. Monica would be an asset to any organization.
Courtney J.
It is a pleasure working with Monica. She is a teamplayer, hardworker, self- starter and a true leader! Monica does a great job being the Manager of Case Management and Quality. She is an asset to any organization!
JB Brown (The Aflac Guy)
Monica is a detailed and professional manager. Her ability to finish assignments and multi-task is paramount. Monica would be an asset to any organization.
Courtney J.
It is a pleasure working with Monica. She is a teamplayer, hardworker, self- starter and a true leader! Monica does a great job being the Manager of Case Management and Quality. She is an asset to any organization!
JB Brown (The Aflac Guy)
Monica is a detailed and professional manager. Her ability to finish assignments and multi-task is paramount. Monica would be an asset to any organization.
Courtney J.
It is a pleasure working with Monica. She is a teamplayer, hardworker, self- starter and a true leader! Monica does a great job being the Manager of Case Management and Quality. She is an asset to any organization!
JB Brown (The Aflac Guy)
Monica is a detailed and professional manager. Her ability to finish assignments and multi-task is paramount. Monica would be an asset to any organization.
Credentials
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CCM Certified
Commission for Case Manager Certification (CCMC)
Experience
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URAC
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United States
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Hospitals and Health Care
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1 - 100 Employee
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Director of Care Management Accreditation
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Mar 2020 - Present
• Responsible for overall operations and oversight of forty-nine Care Management Accreditations. • Serves as the primary contact for accreditation-related questions and requests from clients. • Assists and advises clients and prospective clients through application processes.• Oversees and manages accreditation-related tasks.• Assists with development of program standards.• Monitors accreditation trends and identifies issues.• Prepares candidacy and accreditation decision letters.• Hires department staff and prepares work schedules.• Developed and implemented department training program.
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HEDIS Abstractor Nurse (Seasonal)
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Feb 2015 - Mar 2020
• Review and abstract medical data from medical records• Review assigned medical records in order to abstract specified and required clinical data elements to determine provider performance on specific quality measures.• Perform telecommute medical record abstraction• Comply with appropriate procedures for reviewing records remotely • Document abstraction findings as required and prepare additional reports as needed • Communicate all project issues including scheduling, assignment, and supervisor alerts in a timely manner
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Capitol Bridge
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United States
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Information Technology & Services
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100 - 200 Employee
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Program Manager (Contractor)
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May 2019 - Feb 2020
• Provide direction and oversight of the Centers for Medicare and Medicaid Services (CMS) Center for Program Integrity RAC Validation Contract• Responsible for overall operations for Medical Review.• Compile program management reports, action item collection and monitoring of deliverable submission• Develop standard tracking and reporting tools for effective program management, and a variety of special projects. • Document and track team deliverable in program management tools • Ensure project deliverables are completed and delivered to client timely • Facilitate team meetings, prepare presentations, capture meeting minutes, coordinate team input and responses to CMS request, and ensure effective communication between client and staff • Develop, implement and maintain policies and procedures regarding medical review functions
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Manager, Care Coordination
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Jul 2017 - May 2019
• Provide direction and oversight of all Utilization Management functions, ensuring the activities are aligned with the mission and vision of the organization• Responsible for overall operations for Medical Review • Increase the likelihood of hospital cost reimbursement for patient treatment through insurance by ensure patients fit the medically necessary criteria to be admitted.• Recouped over 1 million dollars in denied claims over a 3-month period• Provide statistics and trend reports for all utilization processes• Serve on a committee to develop strategies to reduce improper admissions and readmissions through integration of utilization management
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Chickasaw Nation Industries, Inc.
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United States
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Government Relations Services
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500 - 600 Employee
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Manager, Medical Review (Contractor)
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Aug 2016 - Jul 2017
• Provided direction and oversight of the Centers for Medicare and Medicaid Services (CMS) Medical Review Task under the Payment Error Rate Measurement (PERM) post payment review contract • Increased the amount of medical services allowable for reimbursement under federal government funding by performing documentation reviews, scrutinizing all billing and medical documentation for correct medical codes and medical data.• Responsible for overall operations for Medical Review • Performed 500 reviews weekly with a 98%accuracy• Developed, implemented and maintained compliance, policies and procedures regarding medical review functions.
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CareFirst BlueCross BlueShield
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United States
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Insurance
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700 & Above Employee
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Case Management Supervisor
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Sep 2014 - Jul 2016
• Provided administrative and clinical supervision in the Case Management Department that supported the Federal Employee Program (FEP) and Patient Centered Medical Home (PCMH)• Acted as point of contact and subject matter expert regarding the FEP Medical Case Management Services• Incorporated principles of managed care and utilization management into case management policies and procedures to ensure the timely flow of case management activities meet program goals and objectives • Assisted with departmental preparation for the URAC/NCQA Accreditation• Performed weekly productivity reviews, case audits and documentation requirements to ensure program compliance • Managed a staff of 22 Registered Nurses throughout the Washington DC, Maryland, and Virginia Area.• Conducted ongoing educational meetings with staff to inform of any regulatory changes, as well as weekly 1:1 staff meetings to review audit findings and improvements
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Johns Hopkins HealthCare
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United States
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Hospitals and Health Care
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300 - 400 Employee
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Supervisor, Medical Review
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Jun 2013 - Sep 2014
• Trained, managed, supervised and evaluated 12 Registered Nurses. • Led the daily operations of the outpatient and inpatient preauthorization units for the delivery of medical review services. • Increased claim review volume by 60% and stabilized core staff, within the first 4-6 months of employment• Cleared backlog of 700 cases, within a 3-month timespan of employment• Participated in the development of processes, systems, and practice metrics; developed department policies, procedures and workflow • Developed and implemented new-hire orientation program• Conducted ongoing educational meetings with staff to inform of any regulatory changes, as well as weekly 1:1 staff meetings to review audit findings and improvements
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StrategicHealthSolutions
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United States
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Hospitals and Health Care
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1 - 100 Employee
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Managed Care Specialist (Contractor)
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Aug 2012 - Jul 2013
•Provided technical assistance to Center for Medicare and Medicaid Center for Program Integrity Division of Plan Oversight and Accountability and Division of Policy and Regulatory Development oversight strategy to monitor for and address potential fraud, waste, and abuse while identifying overall program vulnerabilities and ensuring plan sponsors’ strict adherence to regulatory requirements• Served as a Subject Matter Expert (SME) concerning Medicare Part C and Medicare Part D. • Provided overall national program support for and analysis of Medicare Part C and D program integrity initiatives by focusing on process, operational risks, and program vulnerabilities. • Developed, reviewed and analyzed reports to communicate recommendations for audit methodology, system vulnerabilities, and program vulnerabilities. Due to recommendations, $4 million recovered
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CareFirst BlueCross BlueShield
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United States
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Insurance
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700 & Above Employee
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Hospital Transition Coordinator
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Oct 2011 - Aug 2012
• Responsible for utilization of on-site reviews of adults with commercial insurance • Consulted with the Medical Director for medical necessity determinations and appropriateness of • Serve as a liaison for discharge planning needs between organization Case Managers and the community such as Home Health, Acute Rehab, and Durable Medical Equipment (DME), to support optimal functioning. • Responsible for utilization of on-site reviews of adults with commercial insurance • Consulted with the Medical Director for medical necessity determinations and appropriateness of • Serve as a liaison for discharge planning needs between organization Case Managers and the community such as Home Health, Acute Rehab, and Durable Medical Equipment (DME), to support optimal functioning.
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Palmetto Physician Connections
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United States
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Hospitals and Health Care
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1 - 100 Employee
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Manager, Case/Quality Management (relocated)
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Dec 2010 - Oct 2011
• Developed and implemented a Case Management and Quality Management program for a Managed Medicaid Patient Centered Medical Home startup.• Responsible for overall operations for Case Management and Quality Management • Reviewed analyzes of activities, costs, operations and forecast data to determine progress toward stated goals and statistical/financial purposes• Promoted compliance with federal and state regulations and contractual agreements• Developed and implemented Disease Management Program for Asthma, Diabetes, Hypertension and Maternal Health• Developed, implemented, and maintained compliance with policies, procedures, audit tools and work plans • Developed, implemented, and maintained case management programs to facilitate the use of appropriate medical resources and decrease health plan financial exposure • Reviewed and communicated rules/regulations/standards changes• Designed and implemented compliance strategies• Provided policy/procedure drafts to assure regulatory compliance with standards/goals• Ensured team met established performance metrics and performance guarantees
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Education
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2006 - 2008
University of Phoenix
Masters of Science in Nursing/ Masters of Science in Healthcare Administration, Nursing, Healthcare -
2000 - 2002
Kaplan University
Diploma, Legal Nurse Consulting -
1992 - 1996
South Carolina State University
Bachelor Science in Nursing, Nursing -
1989 - 1992
Orangeburg Wilkinson
Community
