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utilization management coordinator resume example with 9+ years of experience

Jessica
Claire
resumesample@example.com
(555) 432-1000,
, , 100 Montgomery St. 10th Floor
:
Professional Summary

Healthcare professional in both behavior and mental health offering experience prioritizing and delegating team members to meet their daily and monthly goals. Proficient in leadership, customer service, schedule, coordination, and resource allocation. Dedicated to training and mentoring individuals within a productive work culture.

Skills
  • Microsoft Office (Word, Excel)
  • HIPAA Compliance, Case Evaluations
  • Leadership, Teamwork, Customer Service
  • Mentoring, Priority, Diversity, Problem- Solving
  • Reminder Calls, Meeting Support, Time management
  • Social Skills, Tolerance, Empathy, Critical thinking skills
  • Observation, Cooperation, Communication, Listening
  • Empathy, Critical thinking skills, Interpersonal Skills
  • Advocacy, Self- awareness
Education
Westwood College - Dupage Woodridge, IL, Expected in 03/2015 Bachelor of Science : Healthcare Management - GPA :
Work History
Anthem, Inc. - Utilization Management Coordinator
New Orleans, LA, 12/2020 - 10/2022


  • Handled both inbound and outbound calls from providers regarding authorization.
  • Conducted assessment reviews for various mental health conditions including (i.e depression, anxiety disorder, PTSD, ADHD, Bipolar Disorder, schizophrenia, disruptive behavior, dissocial eating disorders and addictive behaviors, etc).
  • Ensure primary care provider preferred method of communication is updated/accurate in the EMR
  • Gather and relay necessary clinical and administrative information to appropriate members of the clinical team for additional review.
  • Worked closely with clinical staff members (I.e Physicians, Advance Practice Providers, Social Workers and RN Nurse Care Managers for additional.
  • Trained 5-10 staff member at a time on learning source training online, update medical record, mentoring, coaching, scheduling, follow-up and patient satisfaction calls.
  • Maintained policies and procedures, guidelines regarding compliance, HIPAA regulatory, local, state and federal benefits.
  • Performed additional duties as needed.


Fiserv - Sr. Care Management Coordinator
Sunnyvale, CA, 12/2016 - 12/2020
  • Conducted transition of care after discharge for follow-up (home visit, over the phone, and various facility.
  • Educated and evaluated clinical and support staff regarding care quality management regulations and standards of care.
  • Created care plan with various assessments based timeline required by the department within HIPAA guidelines ( complex issues, psychosocial, high risk pregnancies, diabetes, blood pressure, treatments, stroke, behavior/mental health and disability.
  • Coordinated referrals to specialists, hospitalizations, ER visits, ancillary testing, and other enabling services for patients.
  • Advocated for other community resources to assist with patients/families and caregiver with all patients healthcare needs.
  • Worked closely with the clinical teams regarding care plan, barriers for certain criteria, treatments, meeting, and team conferences.
  • Participate in Care Coordinator hiring process, training, feedback, performance evaluation, and discipline.
  • Worked on other project as needed.
Family Services Network N Y - Community Habilitation Coordinator P/T
City, STATE, 10/2015 - 11/2017
  • Monitored clients' overall health and well-being and noted significant changes.
  • Transported clients to and from medical appointments with safety and efficiency.
  • Entrusted to handle confidential and sensitive situations in professional matter with disable individuals both adults and kids.
  • Built and maintained rapport with clients and family members to facilitate trusting caregiver relationship.
  • Created /edited monthly reports, prepared documents, provided a checklist, made decisions, and handled any unresolved issues.
    ● Reported any abuse with medication, physical abuse, doctors' appointments, and substance use for the state.
Intergra Health - Team Lead
City, STATE, 07/2013 - 09/2015
  • Trained new team members by relaying information on company procedures and safety requirements on field visit.
  • Established open and professional relationships with team members to achieve quick resolutions for various issues.
  • Managed schedules, accepted time off requests, review annual incentive plan, plan weekly meeting, review consent documentation, follow- up on transportation request, and coordinate with management team to plan other strategies.
  • Interpreted regulations to identify patient care requirement criteria to be monitored and establish systems to achieve compliance.
  • Analyzed key performance indicators to assess and manage risk, evaluating patient care and creating procedural changes to increase efficiency.
  • Evaluated customer service staff performance and provided constructive feedback.

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Resume Overview

School Attended

  • Westwood College - Dupage

Job Titles Held:

  • Utilization Management Coordinator
  • Sr. Care Management Coordinator
  • Community Habilitation Coordinator P/T
  • Team Lead

Degrees

  • Bachelor of Science

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