Customer Service Medical
Resume:
Danielle S. Granat
Profile Director of Utilization Review - Healthcare
Dedicated healthcare professional with more than 20 years of
nursing experience, most recently negotiating with insurance
carriers to determine allotted patient healthcare stays.
Excel in increasing the profitability of the healthcare
facility. Effectively manage healthcare personnel in the
field of utilization review, multiple, high-priority projects
and take pride in providing exemplary customer service.
Key Skills Manage Department Personnel Generate Reports and
Tasking Documentation
Manage Department Costs Confidential Records Management
Coordinate with Physicians,
Upper Management, and Policy Interpretation
Third-Party Administrators Texas State Insurance
Regulations
Experience Sundance Hospital-Arlington TX-Current Director Utilization
Review
University Behavioral Health/Denton - Denton, TX
Director of Utilization Review, 4/07 to 4/11
Performs management of utilization review of health care
services to ensure that patients receive optimal medical care
that is medically necessary and delivered in the appropriate
setting.
Outcomes:
Managed assigned workload within established performance
standards.
Participated in discharge planning process with hospital and
inpatient facility staff, ensuring adequate and appropriate
disposition and post discharge plans.
Coordinated smooth transition and follow-ups from one level of
care and service to another.
Maintained all required documentation in the information
systems.
Participated in case conferences, clinical in-services, and
other educational opportunities.
Recorded information in Claims Management system and
communicated with the Claims Adjuster to process valid medical
treatment requests for authorization per policy.
Sedgwick CMS - Irving, TX
Medical Case Manager, 2004 to 4/07
Managed behavioral health and medical short-term disability
claims and assisted with Workman's Health Compensation claims.
Outcomes:
Determined medical necessity of the requested treatment.
Communicated with requesting providers, service providers,
claims adjusters, and claimants via telephone, e-mail, and fax
to request additional information.
Coordinated care and provided verbal authorization for medical
treatment per policy.
Assisted in medical training for Case Managers.
Maintained ongoing compliance with Federal or state laws, URAC
standards.
Ensured cost effective and quality patient care by appropriate
utilization of medical resources.
Millwood Hospital - Arlington, TX - Director of Utilization
Review, 2001 to 2004
CorpHeath - Ft. Worth, TX - Psychiatric Case Manager, 1998 to
2001
All Saints Hospital - Ft. Worth, TX, - Staff Nurse, 1997 to
1998
John Peter Smith Hospital - Ft. Worth, TX - Psychiatric
Emergency Room Nurse, 1988 to 1997
Education Tarrant County Community College - Ft. Worth, TX - General
Curriculum 1984/86
John Peter Smith Hospital Nursing School - Ft. Worth, TX -
Graduated Licensed Vocational Nurse 1988/89
Arlington Court Reporting College - Arlington, TX - Paralegal
Diploma 1996
Computers APS, Microsoft Excel, Word, Outlook
5712 Blackmon Ct. ( Ft. Worth, TX 76137 ( 817-***-**** (
*********@*****.***
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