Utilization Management Coordinator Resume

RACHAEL ETHERTON

931-***-**** **************@*****.*** HOPKINSVILLE, KY 42240

Reliable worker with excellent communication, time management, and computer skills. A driven and detail- oriented individual with a desire to use analytical and problem-solving skills to meet goals. Strong knowledge in utilization management processes, medical policy guidelines, and healthcare compliance. Highly skilled in coordinating patient care, reviewing medical cases, and ensuring adherence to regulatory standards. Demonstrates solid work ethic, prioritizing efficiency and accuracy to minimize errors. Ready to contribute as Utilization Management Coordinator with thorough understanding of case management, utilization review, and healthcare administration. professional summary

skills

• HIPAA compliance awareness • Critical thinking

• Documentation accuracy • Insurance verification

• Medical terminology • Healthcare regulations

• Data analysis • Multitasking efficiency

• Utilization review expertise • Customer service

• Teamwork • Multitasking

• Verbal and written communication • Medicare compliance

• Quality assurance • Computer skills

experience

UTILIZATION MANAGEMENT

HEALTHCARE COORDINATOR

HIGHMARK BLUE SHIELD,

CHURCH HILL, PA

Mar 2022 - Apr

2025

Maintained current knowledge of

government regulations pertaining

to managed care organizations.

•

Dec 2020

ASSOCIATE IN SCIENCE (A.S.)

IN MEDICAL BILLING AND

CODING

ULTIMATE MEDICAL ACADEMY,

FLORIDA

education

UTILIZATION MANAGEMENT HEALTHCARE

COORDINATOR

Performed assessments of medical

necessity for services rendered by

providers through a comprehensive

evaluation of documentation from

multiple sources.

•

Prepared detailed reports

regarding utilization trends,

outcomes, and other related data.

•

Assessed patient eligibility for

admission into various treatment

programs based on insurance

coverage requirements.

•

Analyzed medical records to

determine appropriateness of

services provided in accordance

with established criteria.

•

Communicated regularly with

healthcare professionals regarding

changes in utilization management

processes or new initiatives.

•

Utilized critical thinking skills when

making decisions related to the

authorization or denial of requested

services.

•

Coordinated appeals process

between provider, member, payer

when authorization is denied or

modified due to noncompliance

with criteria standards.

•

Monitored concurrent reviews, pre-

certifications and authorizations,

and post-service reviews.

•

CALL CENTER CUSTOMER

SERVICE SPECIALIST

Walgreens corporate office, Deerfield,

IL

Dec 2020 - Jun

2021

Adhered to quality assurance

standards when dealing with

customer interactions.

•

Successfully handled difficult

customer inquiries by providing

•

sympathetic understanding and

patience.

Demonstrated ability to provide

excellent customer service in a

fast-paced call center environment.

•

Maintained an up-to-date

knowledge of product offerings and

promotions.

•

Utilized effective communication

techniques to ensure customer

satisfaction.

•

Provided feedback on processes

and procedures for improved

efficiency.

•

Managed large amounts of

incoming calls in a professional

manner.

•

Answered calls, left voicemails,

and scheduled follow-up calls to

drive customer engagement.

•

Used database system to record

notes and call information.

•

Followed established procedures

during calls with customers.

•

Learned company policies, rules

and performance requirements to

achieve successful calling metrics.

•

Fulfilled customer requests by

clarifying desired information and

completing transactions.

•

Used job-related software to

complete contract forms, prepare

change of address records or issue

service discontinuance orders.

•

SCHOOL BUS DRIVER

STEWART COUNTY SCHOOL

SYSTEM, DOVER, TN

Aug 2004 - May

2020

Conducted pre-trip and post-trip

inspections of school bus to verify

safety and functionality.

•

Successfully completed all required

training courses related to school

bus operation and safety.

•

Provided timely pickup and drop-off

of children at designated locations

in accordance with established

schedules.

•

Maintained a safe driving record by

adhering to traffic laws, road safety

regulations, and company policies.

•

Attended regular in-service

meetings to keep current with

school requirements and state and

federal regulations.

•

Monitored students' safety and

well-being while on the bus.

•

Developed positive relationships

with students by displaying

patience, understanding, respect,

and compassion towards them

during transport.

•

Interacted positively with students,

parents, faculty, and staff

members.

•

Responded quickly and

appropriately to any emergency

situations that arose during

transportation.

•

Assisted special needs students in

boarding and exiting the bus safely

while providing them with

appropriate assistance if needed.

•

Assisted with the safe loading and

unloading of special needs

students.

•

Performed minor repairs such as

replacing fuses, light bulbs, and

wiper blades when necessary.

•

Kept bus interiors clean for

students.

•

Maintained knowledge of first-aid

procedures.

•

Reported bus malfunctions or

needed repairs.

•

• Recorded bus routes.

SCHOOL ASSISTANT

STEWART COUNTY SCHOOL

SYSTEM, DOVER, TN

Aug 2004 - May

2019

Communicated effectively with

faculty members regarding any

changes or updates to policies.

•

Ensured that all students had

access to appropriate technology

needed for educational success.

•

Developed strong communication

skills through working with parents,

teachers, administrators, and

students.

•

Utilized organizational skills to

create a filing system for student

documents.

•

Organized and managed the front

office space including supplies,

mail distribution, phone calls.

•

Supported special needs children

by providing extra assistance with

activities or tasks.

•

Demonstrated patience,

compassion, and empathy in

various situations.

•

Supervised students on school

grounds and on field trips.

•

Led small group and individual

instructional sessions.

•

Supported safe, organized

classroom conducive to productive

learning environment.

•

Established constructive

relationships with pupils and staff

members.

•

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