Utilization Management Healthcare Services
Resume:
Jennifer Savage
Bunkie, LA *****
***********@*****.***
Willing to relocate to: Bunkie, LA
Work Experience
Utilization reviewer
EDGEFIELD COUNTY HOSPITAL-Cheneyville, LA
August 2024 to Present
• Conducted comprehensive reviews of medical records to ensure appropriate utilization of healthcare services
• Collaborated with healthcare providers and insurance companies to gather necessary information for review process
• Evaluated medical necessity, appropriateness, and efficiency of requested treatments or procedures
• Identified potential overutilization or underutilization of healthcare resources and recommended corrective actions
• Maintained accurate documentation of all review activities in accordance with regulatory requirements
• Communicated review decisions effectively to healthcare providers, insurance companies, and other relevant parties
• Participated in interdisciplinary team meetings to discuss complex cases and develop appropriate care plans
• Assisted in the development and implementation of utilization management policies and procedures
• Provided education and training on utilization management processes to staff members as needed
• Monitored trends in utilization patterns, identified areas for improvement, and made recommendations for process enhancements
• Ensured compliance with state regulations, accreditation standards, and contractual obligations related to utilization management practices
Discharge planner
Beacon behavioral hospital-Bunkie, LA
August 2014 to December 2023
• Coordinated and managed the care plans for a caseload of clients, ensuring the delivery of high-quality and personalized healthcare services
• Collaborated with healthcare providers, including physicians, nurses, and social workers, to develop and implement comprehensive care plans tailored to the specific needs of each patient
• Conducted initial assessments and ongoing evaluations of clients' health status, identifying areas for intervention and improvement
• Facilitated communication and information flow between healthcare team members, promoting a collaborative and patient-centered approach to care
• Managed and maintained accurate and up-to-date client records, documenting care plans, progress notes, and any changes in health status
• Coordinated and scheduled medical appointments, diagnostic tests, and follow-up visits, optimizing the efficiency of healthcare services
• Provided education and support to clients and their families, empowering them to actively participate in the management of their healthcare needs
• Collaborated with insurance providers to verify coverage, obtain authorizations, and address any billing or reimbursement issues, ensuring seamless access to healthcare services
• Assessed and addressed social determinants of health, connecting clients with community resources, support groups, and social services as needed
• Facilitated support groups and educational workshops for clients, promoting self-management and empowerment in navigating the healthcare system
• Participated in multidisciplinary case conferences, contributing valuable insights and perspectives to enhance the overall care coordination process
Education
High school diploma
Bunkie High School-Bunkie, LA
August 1996 to May 2000
Skills
• Utilization Management
• Word processing (10+ years)
• Administration Assistant duties and rolls (9 years)
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