To obtain a position within a Utilization Department where I can use my experience and expertise for the benefit of the department and for professional growth. Knowledge of process methodology for the improvement of departmental outcomes and decreasing overall cost. Ability to articulate clinical and non clinical information to all individuals Knowledge of McKesson Interqual Guidelines. Power user of Allscripts Medical Management Systems. Knowledge of Medicare Medi-cal, CMS, DHS and Managed Care guidelines. Proficient in obtaining authorization for all referrals prior to rendering medical services. Able to proficiently write denials and management appeals. Experience in providing concurrent reviews in a timely manner while maintaining and monitoring current level of care.
Licensed Vocational Nurse
Medicaid regulations, Medical and clinical services, Medical terminology, MRI, Multi-specialty group practice management, Neurology, Newborn resuscitation, Nursing home, Orthodontic, OSHA regulations, OSHA/FDA, Patient case management, Patient relations, Policy development and implementation, Private practice experience, Project Management, Quality assurance standards, Caseload management, Clinical case analysis, Clinical experience, Clinical practice management, Clinical review, Crisis Intervention, Culturally competent care, Diagnostic testing, Eligibility determination, Health education, TAR submission,Denial and appeals review and submission, coding, Authorization of Inpatient admission, surgeries,chemo, IRB studies, outpatient ambulatory surgeries
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