Experience

Dignity Health Management Services Organization

• United States
• Hospitals and Health Care
• 100 - 200 Employee

• Utilization Management Supervisor

  • Jun 2023 - Present

• Utilization Management Supervisor

  • Dec 2019 - Jun 2023

  • Communicate effectively and interact with the Utilization Management Department and Health Plans as needed, regarding UM and referral authorization issues.• Planning, assigning, and directing coordinator tasks as necessary • Disseminate leadership updates to direct reports• Interviewing, training, and orientation of new employees • Responsible for monitoring pended authorization maintenance, tracking, and assigning coordinator follow up.• Responsible for overseeing the EIOD process; including log maintenance and member notifications.• Oversee UM coordinators quality and compliance benchmarks are met by conducting monthly audits• Oversee transplant cases and coordination of care with Health Plans• Creation and facilitation of guidelines and workflows to enhance UM productivity and quality• Maintain all reference materials that are provided by the supervisor, manager or director.• Maintain regulatory Turn Around Time Standards per CMS (Seniors) and ICE (Commercial).• Responsible for running and assigning daily integrity reports for UM quality measures • Function as a resource for Utilization Management, Case Management, Customer Service, Provider Relations, Contracting, Claims, and other neighboring departments.• Work closely with IT department to develop reporting and scripts• Attend Departmental and Collaborative/OPS meetings pertaining to Utilization Management practices Show less

• Utilization Management Lead

  • Aug 2018 - Dec 2019

• Utilization Management Coordinator

  • Jan 2018 - Jul 2018



Managed Care Systems, LP

• United States
• Insurance
• 1 - 100 Employee

• Administrative Assistant

  • Jun 2017 - Dec 2017



Mindbody

• United States
• Wellness and Fitness Services
• 700 & Above Employee

• Client Care Specialist

  • Nov 2015 - May 2017

  Verifying ownership and security for the Subscriber Data Exports process (the releasing of unencrypted credit card data upon account termination) - remaining as Point of Contact throughout, assisting clients with managing their subscriptions (via phone and written communications), attempting to retain clients and provide documentation on their experience (via phone and written communications), deescalating clients due to bad experiences, and further tasking duties as requested. Verifying ownership and security for the Subscriber Data Exports process (the releasing of unencrypted credit card data upon account termination) - remaining as Point of Contact throughout, assisting clients with managing their subscriptions (via phone and written communications), attempting to retain clients and provide documentation on their experience (via phone and written communications), deescalating clients due to bad experiences, and further tasking duties as requested.



Suncoast Insurance Services

• Arroyo Grande, CA

• Licensed Customer Service Representative

  • May 2014 - Nov 2015

  Review and add or reduce insurance coverages based on customer’s risks and needs, support with claims process, cross-sell additional insurance products, manage daily customer requests, other administrative duties. Review and add or reduce insurance coverages based on customer’s risks and needs, support with claims process, cross-sell additional insurance products, manage daily customer requests, other administrative duties.



Allstate Insurance Company

• Diamond Bar, CA

• Claims Service Specialist

  • Nov 2013 - Apr 2014

  File new claims, answer inquiries on existing claims, review coverages and claims process, meet daily and weekly service goals File new claims, answer inquiries on existing claims, review coverages and claims process, meet daily and weekly service goals



Northrange Behavioral Health

• Greeley, Colorado, United States

• Administrative Assistant

  • Jul 2013 - Nov 2013

  Taking client payments, client admissions (administrative), client scheduling, filing medical documents, answering multi-line telephones, keeping up with client attendance, fulfilling client requests, and other administrative duties. Taking client payments, client admissions (administrative), client scheduling, filing medical documents, answering multi-line telephones, keeping up with client attendance, fulfilling client requests, and other administrative duties.



Centennial Mental Health Center

• Fort Morgan, CO

• Office Assistant II

  • Jun 2012 - Jul 2013

  Greeting clients, taking client payments, client admissions (administrative), client discharges (administrative), client scheduling, insurance verifications, filing medical documents, answering multi-line telephones, keeping up with client attendance, fulfilling client requests, and other administrative duties. Greeting clients, taking client payments, client admissions (administrative), client discharges (administrative), client scheduling, insurance verifications, filing medical documents, answering multi-line telephones, keeping up with client attendance, fulfilling client requests, and other administrative duties.