EDUCATION

National University San Diego, CA

Master of Public Health, Health Promotion September 2016 – March 2018

Manubhai Patel Dental College Vadodara, Gujarat

Bachelor of Dental Surgery June 2011-May 2015

PROFESSIONAL EXPERIENCE

Prime HEalthcare Ontario, California

Supervisor-Utilization Review February 2021 - Present

Monitors authorization process for traditional Medicaid and commercial payors.

Assists in improving data quality and compliance reports.

Participates in deployment, implementation, and enhancement of Authorization tool.

Provides training and conducted assessment to new hired employee.

Responsible for designing, producing and/or updating any new or existing materials needed to educate staff

Prime Healthcare Ontario, California

Medical Review Coordinator September 2020 – February 2021

Oversaw Utilization-Review process for 45 Prime Healthcare Facilities.

Facilitated meetings with the facility case management department to identify gaps in the Authorization Process.

Monitored Authorization process for commercial payors and assisted in improving data quality of compliance reports.

Worked with CMOs, CBOs, CFOs, Regional Directors and Physicians with regards to admission criteria, medical necessity, payment denials, and documentation issues.

Prime Healthcare Ontario, California Utilization Review Coordinator July 2018 - September 2020

Coordinated and assisted in clinical reviews for Utilization Review Process.

Served as on-going educator to departments including onsite and remote utilization review team.

Onboarded the “treatment authorization request” process for Prime Healthcare Facilities in CA, GA, MO and NV while continuing to oversee logistics of onboarding new facilities and maintaining efficacy in work production.

Alzheimer’s Association Imperial Chapter San Diego, California

Health Educator Intern November 2017 - December 2017

Developed and implemented health education program.

Conducted community outreach and prepared materials to support community activities, educational program, and marketing.

Attended and facilitate site meeting and served as a community health education resource.

Care 32 Dental Clinic Gujarat, India

Dental clinic specializing in oral surgeries and general dental care June 2015 - May 2016

Associate Dentist

Examined patients with dental anomalies including oral cancers and interpreted radiographs and diagnostic tests to diagnose dental illnesses.

Treated dental abnormalities by performing root canals, tooth extractions, scaling, and denture construction.

Created preventative treatment plans and educated patients on dental health. Monitored patient volume and maintained patient records.

Manu Bhai Patel Dental College Gujarat, India

Intern May 2014 - May 2015

Provided patient consultations on dental needs.

Created various public health promotion events and education forums in underprivileged areas and schools. Conducted campaign in rural areas to spread awareness on harmful effects and consequence of tobacco smoking or sniffing.

Presented oral health prevention through study models, charts, posters, and other visual presentation.

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