Yvette Gutierrez

**** * ** *** ** Lot *

San Antonio, TX 78245

ad3x4m@r.postjobfree.com; 210-***-****

Education:

Por Vida Academy, HS Diploma 6/2004

Work History:

ICare Health Solutions 2/2023-Present

Utilization Management Coordinator

Sends peer to peer request to providers via email

Creates peer to peer meetings for Medical Director

Peer to Peer conference calls with MD and Providers

Request additional information from providers

Processes Denials, Withdrawal, Voids, approvals

Communicates with Providers via email/phone

Reviews medical records prior to sending for review

Direct contact with Medical Directors

United Health Group 4/2017-1/2023 Utilization Management & Hospital Intake Coordinator

Processes referrals for providers

Processes hospital intake request by fax

Creates prior authorizations

Creates concurrent review authorizations

Takes inbound calls from queue

Attaches medical records to authorization

Fax out approval letters

Meets required production stats

Creates peer to peer request for Medical Director

Cameron Tucker Agency-Humana, Inc. 2/2008 - 1/2017

Data Entry-Case Management Specialist

•Meet quality audit standards of 95% or higher; achieve regional lag time goal of less than 1%

•Independently manage over 500 cases and faxes per week

•Manage daily report for leadership

•Monitor queue on receiving authorizations

•Manage maternity & Medicare inpatient members’ authorizations until discharged

•Make outbound calls to hospitals for clinical information

•Send faxed forms for clinical or discharge authorization

•Built authorizations upon request from nurses as needed

•Updated hospital addresses per the request of leadership

•Use multiple systems to research information

•Received faxes from PCP (Primary Care Provider) on referral to a Specialist

•Directed referrals to nurses

•Researched maternity and Medicare members

•Made outbound calls to obtain discharge dates

•Attached faxes to authorizations

West Corporation

Customer Service Representative 2/2007 - 1/2008

Fallas Paredes

Lead Cashier 3/2003 - 2/2006

Taco Bell

Shift Manager 1/1999 - 3/2002

Technical Skills

Microsoft Word, Excel, CGX, CCP2, GCP, PMDM, Rightfax, Outlook, Avaya, IKA, TruCare, Medesis, Quickbase, Ehealthdeck, Teams

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