Case Manager Utilization Review
Resume:
Yaney Molina
**** **** **** ******, *** *****, Hialeah, FL 33016
786-***-**** ********@*****.***
Objective: To provide and utilize over 26 years of experience in a way that provides advocacy for the patients, and also contribute to the overall success of the facility in a position of diverse responsibility which requires strong organizational, planning, problem-solving and follow-through skills.
Professional Achievements BACHELORS OF SCIENCE IN PSYCHOLOGY
Health Care Risk Management Certified at Florida International University 2017
Associate in Nursing completed at ASHOD Hebrew University, Graduated May, 2024
Certified Case Manager Certification with CCMC in progress
Graduate with a Bachelors in Psychology Magna Cum Laude Honor Roll
Clinical Hours done at Citrus Health Network utilizing Psychological Skills with the adolescents and Adult patients
Strong critical thinking abilities and making decision process
Empathetic understanding in various settings utilizing diverse multicultural skills
Ability to handle multiple tasks and priorities simultaneously
Ability to coordinate, manage multiple tasks and independently, as well as being a good team asset
Strong interpersonal skills
Excellent communication and organizational skills
Excellent customer service and problem solving abilities
Complete knowledge of Utilization Review process Medicare and HMO’s
Utilization Review Process and Hospital length of Stay course, knowledgeable in all DRG’s
Knowledgeable in Utilization Review using Medicare Guidelines criteria tools Interqual and Milliman, also submitting Reviews to Medicaid/ EQ Health System
Complete knowledge of all con-current reviews
Complete insight in identifying Risk Management cases and working closely with the proper staff
Overall management of case management evaluations making sure of all clinical care coordination meets all patients’ needs.
Work History Gap Reason: Completed RN associates
Social Worker
UR Case Manager, Discharge planner, Social Worker
Palmetto General Hospital August 2023 to Present
Steward/North Shore Medical and Steward/ January 9th 2023 to July28th 2023
Larkin Palm Springs Campus Hospital, January 2008 to October 2022
Palm Springs Hospital 1996 to 2022/ Facility sold to Larkin Palm springs Campus
Responsibilities:
As a Discharge planner/Social work main focus was to assess patient’s needs in specific situations.
Developing thereafter and implementing an intervention plan accordingly with clinicians and multidisciplinary team involved in the care of the patient.
Referring patient with Community Resources and services needed as part of the discharge plan coordination.
Documenting patient’s interactions and progress in the Discharge planning referral.
Collaborating with professionals involved in the care of the patient.
Referring patient to facilities of their choice following insurance’s guidelines and discharge criteria.
Advocating always for a safe Discharge plan and collaborating with supports system and other health care professionals involved.
Responsibilities:
As a Case Manager/ duties included
Reviewing clinical criteria with proper DRG’s daily ensuring appropriate admission level of care with diagnosis and treatment to follow.
Screen, Assess, Evaluate risks, and follow up appropriate level of care with referral resources.
Managing timely admission review and concurrent reviews with patient flow of 25-30 daily at times.
Collaborate with Interdisciplinary teams and other health care professionals involved in the care to
Ensuring proper referrals for the appropriate level of care needed once a safe discharge is in place.
Advocate for patient centered-care to ensure resource utilization and a proper utilization Review with private HMO’s and Medicare/ Medicaid, following CMS guidelines.
Overall assess, identify and monitor proper referrals according to level of care ensuring a cost effective plan reducing length of Stay and re-admissions.
Switchboard Operator
Palm Springs General Hospital, Hialeah, Fl 33012 August 1996 to 2008
Responsibilities:
Excellent communication and organizational skills
Excellent customer service and problem solving abilities
Strong interpersonal skills
Ability to handle multiple tasks and priorities simultaneously
Education:
Bachelor of Science in Psychology
Carlos Albizu University, Miami, FL 33172 / Graduated December 2007
Health Care Risk Management Certification at FIU in December 2017
ASN at Ashod Hebrew University Graduated April 2024
References available on request as well as all certifications.
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