MARTINE SUMMERSET

**** *.*. ******** ****.

Hope Sound, FL 33455

772-***-****

adven2@r.postjobfree.com

OBJECTIVE: Seeking employment opportunity that values solid academic foundation, strong interpersonal and teamwork skills, and high-energy performance that has positive impact on organizational goals.

SUMMARY: Service representative with over 20 years of experience in professional service-oriented environments. Extensive versatile background that includes but is not limited to physical therapeutics, research, analyst, inventory management, purchasing, procurement management, accounts payable, and contract administration. I am a responsible, hardworking, enthusiastic, and highly motivated self-starter, with excellent organization and bi-lingual communication skills.

PROFESSIONAL

EXPERIENCE: EVICORE HEALTHCARE, Bluffton, SC July 2017-PRESENT UTILIZATION REVIEW SR. ANALYST

Responsibilities include applying established clinical guidelines and utilization management protocols to effectively evaluate requests for physical therapy services to determine the appropriateness of the requested services for authorization for members in the pediatric and adult populations. Emphasize building provider relations, contributing to organizational growth, and achieving departmental objectives. Conduct thorough review of medical reports and clinical documentation submitted by national therapy providers who are requesting or providing therapeutic services to adult and pediatric recipients. Complete clinical reviews based on the policy’s medical necessity and cost-effectiveness established by managed care organization and program guidelines. Maintain strict adherence to applicable government regulations for respective programs including Medicare, Medicaid and Commercial programs. Perform pre-authorization of initial, concurrent and retrospective requests to assess the validity of admissions. Determine the necessity of continued therapeutic services, length of stay, intensity of therapy, episodes of care, efficiency of utilization of therapeutic services and patients' progress. Contact providers for peer-to-peer consults regarding submitted documentation to ensure adherence of evidenced-based therapeutic practices. Conduct quality assurance audits for therapy disciplines based on departmental protocol(s) and provide critical feedback to clinical reviewers to improve overall quality and inter-rater reliability. Complete appeal review summaries for cases in which providers request reconsideration of therapeutic services after an adverse determination of the initial pre-authorization request occurs. PRN, Treasure Coast January 2010-July

2017

PHYSICAL THERAPIST

Provided Physical Therapy services at multiple facilities including home health and SNF. Responsibilities included consulting with patients and their care takers on their medical history, evaluate patient mobility, balance, coordination, and physical function. Created patient treatment plans to reduce pain or enhance mobility. Demonstrated exercises, movements, and home workouts. Assessed patient progress and adjusted the plan. Coordinated with the patient’s primary care physician and other medical professionals. Advised family members of patient progress and provided functional supervision to physical therapy assistants and aides.

GENTIVA HEALTH SERVICES, Port St. Lucie February 2007-December 2009 ORTHOPEDICS PROGRAM DIRCTOR

Directed staff recruitment, retention, and overall marketing of healthcare services to all customers within the community activities. Duties included managing daily performance improvements, data collection, inventory control, and QA/PI reporting, while maintaining compliance with JCAHO survey standards and state regulators. Conducted in-service MARTINE SUMMERSET

7882 S.E. Heritage Blvd.

Hope Sound, FL 33455

772-***-****

adven2@r.postjobfree.com

training, and monitoring patient evaluation/treatment processes for two locations. Managed department’s annual budget monitored revenue and expenditures. SOUTH TEXAS REHABILITATION HOSPITAL, Brownsville, TX March 2004- December 2007

DIRECTOR OF THERAPY OPERATIONS

Director, responsible for overseeing all recruitment/retention, new business development, implementation of policies and procedures, and operational budget. Served as the primary point of contact directing the start-up and expansion of a state-of-the-art, freestanding acute rehabilitation hospital. Successfully completed TDH/JCAHO surveys. Maintained performance improvement, data collection, marketing, and inventory control. Initiated process improvement and marketing strategies, Instrumental in the efficient running of all aspects of the hospital’s patient and employee relations departments. VALLEY REGIONAL MEDICAL CENTER, Brownsville, TX February 2000-February 2004

DIRECTOR OF THERAPY OPERATIONS

Managed the day-to-day clinical and administrative operations in a 206-bed acute care inpatient and outpatient hospital setting.

Successfully marketed the physical, occupational, speech therapies, hyperbaric and wound care units to community with 50% increase in departmental revenue. EDUCATION: Master’s in Business Administration, Western Governors University, 2008 Salt Lake City, UT

Bachelor of Science, Florida International University, Physical Therapy 1996 Miami, Florida

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