Utilization Management Patient Care Coordinator

Malyn Greenwood

Plano, TX ***** 323-***-**** **********@*****.***

Professional Summary

Healthcare professional with 20+ years of experience in patient care coordination, utilization management, and medical records administration. Skilled in ICD-10 coding, HIPAA compliance, and EMR systems (EPIC, HealthConnect, Facets). Proven ability to manage high-volume caseloads, resolve complex cases, and deliver exceptional patient-centered service in fast-paced environments.

Professional Experience

Kaiser Permanente – Downey, CA Oct 2022 – Jun 2024

Utilization Analyst – BHC Utilization Management Dept.

• Processed and verified psychiatric admissions, ensuring accurate eligibility and timely placement.

• Generated daily census reports and supported case managers with updates on complex cases.

• Coordinated discharge planning and facilitated communication between external facilities and Kaiser clinics.

• Scheduled MD-to-MD consultations for complex cases and arranged follow-up appointments.

• Provided documentation for claims reviews, authorizations, and denial letters.

• Supported leadership with administrative tasks, ensuring efficient departmental operations.

Kaiser Permanente – Downey, CA Sep 2011 – Oct 2022

Utilization Analyst – BHC Bed Finding Dept.

• Facilitated inpatient psychiatric placements for patients under voluntary and involuntary status.

• Verified benefits and eligibility, coordinated with EDs, clinics, and contract facilities.

• Confirmed medical clearance, secured psychiatric authorizations, and scheduled transfers.

• Collaborated with psychiatrists, RNs, and case managers to ensure smooth patient transitions.

• Managed high-volume caseloads and documented interactions in EMR systems.

• Supported outpatient providers with timely updates and case tracking.

Kaiser Permanente – Downey, CA Aug 2010 – Sep 2011

Utilization Analyst – COUM Case Management Dept.

• Managed cases for members admitted to non-Kaiser facilities, supporting daily reviews.

• Assisted case managers in repatriating members to Kaiser facilities and arranging transportation.

• Communicated with external providers regarding eligibility, admissions, and discharges.

• Issued authorizations and denial letters, ensuring patients and providers received updates.

• Maintained accurate electronic filing and supported continuity of care.

United Healthcare – Las Vegas, NV Oct 2007 – Aug 2010

Associate Clinical Admin Coordinator

• Created and processed referrals in Q and Facets systems with accurate ICD-9 coding.

• Coordinated discharges and transfers to SNFs, LTACs, and home care providers.

• Arranged medical transportation including BLS, ALS, and CCT.

• Liaised with contracted facilities and provided timely updates to case managers.

• Documented referrals and cancellations in nightly transport logs.

Sierra Health Services – Las Vegas, NV May 2005 – Jun 2007

Care Coordination Assistant

• Tracked inpatient admissions and discharges across contracted hospitals.

• Created admission cases and entered ICD-9, CPT, and HCPCS codes.

• Assisted nurses with utilization reviews and discharge planning.

• Coordinated patient transitions to SNFs, LTACs, and rehabilitation centers.

• Supported case managers with daily utilization review updates.

Kaiser Permanente – Los Angeles, CA Jul 2001 – May 2005

Care Coordination Clerk – COUM Dept.

• Opened and managed cases for members treated in non-Kaiser ERs.

• Verified eligibility and documented ICD-9 codes in patient charts.

• Assisted case managers with documentation and additional clinical requests.

• Issued authorizations/denial letters and communicated outcomes.

• Maintained and archived medical records in compliance with HIPAA.

Education & Certifications

Certified Professional Coder – The Coding Source, Los Angeles, CA (Dec 2004)

Certified Nursing Assistant & Home Health Aide – Advance Education Nursing School, Los Angeles, CA (Dec 1999)

High School Diploma – Eagle Rock High School, Los Angeles, CA (Jun 1998)

Skills

• Patient Care Coordination & Utilization Management

• ICD-10 Coding & Medical Terminology

• HIPAA Compliance & Patient Privacy

• EMR Systems: EPIC, HealthConnect, Facets, IDX

• Microsoft Office Suite (Word, Excel, Teams)

• Communication, Time Management, Multitasking

• Fast paced Call Center & Customer Service

• Claims Review & Authorization Letters

• Patient Placement & Transfer Logistics

• Typing Speed: 50 WPM

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