Utilization Review Specialist Team Lead

• Jul 2023 - Present

Utilization Review Specialist

• May 2022 - Jun 2023

• Provide prior authorization support for Utilization Review and Care Coordination including receipt of various documentations requests via fax, e-mail, and phone• Subject matter expert (SME) for surgical and outpatient procedure prior authorization requests• Participate in investigatory activities including quality and Inter-Rater Reliability (IRR) audits• Attend and contribute to weekly Utilization Review team huddles• Adhere to administrative laws and rules set forth by the Oregon Health Authority• Tabulate and provide internal reporting twice daily• Address external stakeholder questions and concerns regarding prior authorization submission and processing Show less

Regional Lead - Patient Care Navigation

• Nov 2020 - May 2022

• Oversee day to day operations of West Coast Region Navigation team including recruiting, interviewing, mentoring, training, and driving performance metrics• Introduced automation into workflow resulting in a 23% increase of patients receiving service• Maintained staff schedules ensuring proper department coverage; this included vacation / sick call coverage and call queue oversight• Created and communicated monthly performance data to stakeholders• Review and submit team timecards for on-time payroll processing• Evaluated new business to ensure value and high return of investment with development team• Support Navigation Physician Champion to implement community workflow enhancements and outreach programs • Collaborate with other division leads on ad hoc projects and initiatives; including new contract start-up's and systems implementation• Developed navigation onboarding training program to ensure consistent training approach • Participate in Quarterly Business Reviews of program successes and opportunities • Establish and maintain collaborative relationships with hospital leadership and other community support agencies • Provide referral services for clients who need assistance from other community partners, such as: housing, food, transportation, insurance, primary health care providers, etc.• Maintain patient Protected Health Information (PHI) in accordance with both state and federal HIPAA laws Show less

Patient Care Navigator - Readmissions

• Jan 2019 - Nov 2020

• Perform proactive and reactive patient navigation duties for 90 days post discharge; engaging with patients multiple times during their episode of care• Coordinate care of Durable Medical Equipment (DME), home health orders, follow up appointments, and medication refill requests • Patient advocate if patient readmitts to acute setting by communicating directly with emergency room physicians and hospitalists • Support Readmission Physician Champion by co-chairing a Readmission Committee, where a multidisciplinary team collaborates to reduce readmissions• Collaborate with other specialty navigators to develop symbiotic process flows• Provide program reporting upon request• Coordinate technology collaborative expanding information sharing among community partners for high risk patients• Establish and maintain relationship with other community support agencies • Provide referral services for clients who need assistance from other community partners, such as: housing, food, transportation, insurance, primary health care providers, etc.• Maintain patient Protected Health Information (PHI) in accordance with both state and federal HIPAA laws Show less

Access Coordinator

• Aug 2018 - Dec 2018

• Coordinate access of care for clients who seek mental health services, both in person and via the phone • Assist in the management of day-to-day office activities including filing, faxing, scanning, and answering phones • Provide clerical support to clinical family therapists, social workers, and psychologists by maintaining clinic schedules • Perform behavioral service screenings and schedule client according to Coordinated Care Organization metric • Monitors daily appointment reminder system ensuring all scheduled appointments receive timely automated reminders • Obtain annual electronic signatures for client consent, fee agreement, and notice of privacy policy • Provide clinicians with weekly reporting tools regarding client treatment plans • Confirm client insurance eligibility through MMIS and Noridian online platforms • Provide referral services for clients who need assistance from other community partners, such as: housing, food, transportation, insurance, primary health care providers, etc. • Maintain patient Protected Health Information (PHI) in accordance with both state and federal HIPAA laws • Process referrals from community primary care providers, Child Protective Services, and Juvenile Corrections Program Show less

Mental Health Service Work Study

• Apr 2017 - Jul 2018

• Assist Mental Health Service Administrative Officer with personnel files; including filing of annual reviews, provider credentials, and personnel feedback • Collect and maintain monthly logs for government operated vehicles • Create and mail monthly “Caring Cards” to high-risk veterans • Coordinate and schedule interviews for open positions in service • Execute special projects in the service to include creation of program flyers and patient out reach mailings • Attend weekly operations meetings. • Attend monthly executive counsel meetings, which address concerns from veteran advocates, while building partnerships Show less

Retail Merchandiser

• Oct 2016 - Apr 2017

• Act as a point of contact and product representative for store management, store staff, and customers • Receive, stock, and circulate merchandise • Promptly and timely rotate seasonal merchandise • Assist other retail merchandisers, in region, by providing vacation coverage • Accurately and promptly communicate store questions, concerns, and feedback to regional leadership • Act as a point of contact and product representative for store management, store staff, and customers • Receive, stock, and circulate merchandise • Promptly and timely rotate seasonal merchandise • Assist other retail merchandisers, in region, by providing vacation coverage • Accurately and promptly communicate store questions, concerns, and feedback to regional leadership

Core Services Team Lead

• Jun 2015 - Nov 2015

As Core Services Team Lead I grew our station's Core Service program offering by providing more Red Cross health care volunteers the opportunity to use their credentials and licenses in Aviano's MTF (Military Treatment Facility). I also oversaw our station’s resiliency program by partnering with Wounded Warrior Project to host base wide events and began laying a foundation for Reconnection Workshops. • Nurtured relationship between the American Red Cross – Aviano SAF station and MTF (Military Treatment Facility) commanders to grow the number of American Red Cross healthcare volunteers, resulting in Aviano Red Cross 2015 Third Quarter Volunteer of the Month. • Developed, implemented, and maintained credentialing and licensing database for all American Red Cross healthcare volunteers. • Reviewed volunteer applications and interviewed prospective Red Cross healthcare volunteers. • Planned, implemented, and executed a lunch for 204 Aviano Air Force MTF (Military Treatment Facility) members; introducing a newly established partnership between the American Red Cross and Wounded Warrior Project. • Attended weekly Red Cross Leadership meetings and monthly base Station Advisory Counsel meetings. • Established policies and volunteer standards for health care volunteers that supported the direction of clinic commanders. • Supported other American Red Cross programs by partnering with my fellow program leads. • Supported American Red Cross station initiatives by providing information to perspective volunteers at base events, staffed the Recovery Station for ASBP (Armed Services Blood Program) blood drives, and regularly staffed our Red Cross Info Desk inside Aviano's MTF (Military Treatment Facility). Show less

Wound Care Patient Care Tech

• Mar 2014 - Apr 2015

• Regularly provided coverage for permanent Wound Clinic Front Desk personnel so they could attend training, meetings, and personal vacations.• Acted as a first point of contact for patients, patients’ families, nursing staff, surgeons and their office staff via phone calls and walk-in clinic visits. • Dutifully collected insurance co-payments in accordance to clinic policy.• Implemented “first in/first out” practice in Wound Care Center's patient rooms and main supply room.• Consolidated excess supply inventory in patient rooms resulting in a decrease of the clinic's supply / linen spend by $ 43K for the fourth quarter of 2014.• Assisted nursing staff with patient care to include gathering vital signs and blood glucose levels.• Removed wound dressings, would vacs, and casts according to clinic and industry standards insuring patient and staff safety. Show less

Pre-Surgery Clinic & Out-Patient Surgery Patient Care Tech

• Aug 2011 - Mar 2014

• Proactively schedule Pre-Surgical patients for Pre-Surgery Testing appointment with the Department of Anesthesia, resulting in Celebrate Your Colleagues recognition.• Precisely compile surgical charts for next-day’s surgery schedule; including all pre-surgical testing documentation, History & Physicals, and consents.• Act as a first point on contact for patients, patients’ families, nursing staff, surgeons and their office staff via phone calls and walk-in clinic visits, resulting in Aspen Award recognition.• Compile next-day’s Pre-Surgery Testing schedule for two registered nurses.• Performed POC (Point of Care) Laboratory tests for surgical patients to include urine pregnancy tests and blood glucose.• Assisted nursing staff with care of both pre and post surgical patients to include gathering vital signs, ambulation, and discharge procedures.• Placed all physician orders for pre-surgical testing to include Laboratory and Radiology tests. • Assisted patients with ADL's (Activities of Daily Living) to include dressing with post surgical dressings, drains, and immobility devices.• Processed all patient recovery charges, at the end of each shift, adhering to hospital policy for prompt patient billing. Show less