DANITA MOORE
Victorville,CA
Summary
Dedicated Care Coordinator with over 20 years of expertise in healthcare management and patient centered coordination in CM/UM. Possessing strong collaborative, detail oriented, time efficient leadership skills which allows for great adaptability in any environment.
Overview
26
26
years of professional experience
Work History
Intensive Case Management- After Hours Coordinator
UCLA Faculty Practice Group
Los Angeles, California
07.2024 - Current
- Provide timely care coordination for CM enrolled patients and Medicare Advantage high risk patients to prevent hospital utilization.
- Process urgent, routine, pre-service and retro authorization
- Identifying UCLA Med Group high risk patients based on criteria to be discussed in various communication huddle platforms i.e., daily huddle, High risk hospital meetings, Skilled Nursing facility rounds.
- Collaborating with nurse case managers in domestic and non-domestic hospital including SNF for ancillary services authorization, coordination and monitoring of delivery of services.
- Care Coordination to prevent inpatient and ED admission
- Facilitate coordination for ED Diversion
- Conduct patient outreach for Post discharge health screening
- Ensure coordination and timely delivery of DME, Home Heath and other post acute care services.
- After Hours Handoff support on pending DME, Home Health, Transfers, post discharge outreach
Care Navigator
Crossover Health
03.2021 - 05.2024
- High volume referral processing across multiple markets within Salesforce.
- Insurance verification, explaining eligibility of benefits to members.
- Identifying and connecting members with community resources, financial assistance programs and other support services.
- Responsible for all new hire training within care navigation.
- Developed community and mental health resource guide.
- Facilitating effective collaboration among members and providers.
Utilization Coordinator
Choice Medical Group
Apple Valley, California
01.2019 - 02.2021
- Accurate chart review and follow up to ensure medical necessity for all referrals.
- Executed within compliance guidelines turnaround times for urgent and standard referrals.
- Patients/Providers; high volume in bound calls regarding referral status.
- Meticulous in maintaining up to date patient records.
- Played key role in the vetting and management of third-party services.
CM Care Coordinator
CareMore Healthcare
Apple Valley, California
01.2007 - 12.2017
- Perform Telephonic clinical rounds with providers for discharge planning.
- Identifying potential issues in care plans and implementing solutions promptly.
- Maintain accurate and complete documentation in EMR-Centrix.
- Authorizes and coordinates services (DME,HH,SNF etc.)
- Coordinate patient care via follow up calls, coordination of services and answering questions.
Utilization Review Technician
Arrowhead Medical Regional Center
Colton, CA
04.2000 - 10.2005
- Perform Telephonic concurrent review for all med/surge and burn patients.
- Worked with onsite Medi-Cal RN on reimbursement of payments.
- Assisted case managers with discharge planning – arranging home health and DME.
- Reviewed medical record chart and prepared summaries to obtain authorization for surgical procedures from insurances.
- Wrote concurrent review on Medi-Cal inpatients in a variety of clinical settings.
- Processed 60/70 TARS per day for authorization of treatment.
- Verifies insurance eligibility, benefits and obtains authorizations.
Education
High School Diploma -
Pacific High School
San Bernardino, CA06.1997
Skills
- MS Office Suites, NexGen
- EMR, EZ-Cap, Epic
- Salesforce, Elation, RightFax
- Medical Terminology
- ICD 9/10, CPT coding
- Multitasking and organization
- Decision-making
Timeline
Intensive Case Management- After Hours Coordinator
UCLA Faculty Practice Group
07.2024 - Current
Care Navigator
Crossover Health
03.2021 - 05.2024
Utilization Coordinator
Choice Medical Group
01.2019 - 02.2021
CM Care Coordinator
CareMore Healthcare
01.2007 - 12.2017
Utilization Review Technician
Arrowhead Medical Regional Center
04.2000 - 10.2005
High School Diploma -
Pacific High School