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, CA
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
San Bernardino
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
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
Cerritos
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
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, CA
06.1997
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
Wraparound Facilitation-Intensive Case Management at The Harris Center for Mental Health and IDDWraparound Facilitation-Intensive Case Management at The Harris Center for Mental Health and IDD
<ul>
<li>Hours per week: 40.</li>
</ul>
<p><strong>Duties, Accomplishments, and Related Skills:</strong></p>
<ul>
<li>Supervise and coordinate daily administrative workflows for a team of 15 employees, ensuring timely task execution, adherence to protocols, and consistent performance monitoring.</li>
<li>Maintain accurate records and documentation related to property intake, detainee processing, transportation, and deportation; verify and audit files to ensure regulatory compliance, and data integrity.</li>
<li>Execute high-volume data entry (up to 8 hours per day), including the entry of case notes, customs documentation, custody logs, and internal reports into secure federal databases.</li>
<li>Develop, review, and edit administrative reports and forms for internal use and government audits; ensure completeness, accuracy, and policy alignment.</li>
<li>Serve as the primary liaison between facility staff, supervisors, and stakeholders; facilitate clear, professional communication, and documentation flow across departments.</li>
<li>Identified discrepancies in data entries and corrected them accordingly.</li>
<li>Oversee inventory control processes, including the secure receipt, tracking, and storage of personal property, using standardized procedures and government tracking systems.</li>
<li>Conduct routine audits and quality control reviews to ensure that administrative practices meet federal operational standards.</li>
<li>Apply sound judgment to evaluate options, solve problems, and make informed recommendations on administrative and operational matters, contributing to efficient workflow management, and compliance with agency standards.</li>
<li>Assist in developing and revising privacy and security policies concerning Personally Identifiable Information (PII); identify potential compliance risks, and recommend solutions.</li>
<li>Coordinate logistics for detainee transportation to court and medical appointments, manage schedules, and track movement through detailed administrative planning.</li>
<li>Conduct roll calls, and ensure accountability through diligent documentation, system updates, and status reporting.</li>
</ul>
<p>Supervisor: Scott Jackson (949) 456-2706.</p>
<p>Permission to contact: Yes.</p> at ProTech USA LLC, Government Contracting<ul>
<li>Hours per week: 40.</li>
</ul>
<p><strong>Duties, Accomplishments, and Related Skills:</strong></p>
<ul>
<li>Supervise and coordinate daily administrative workflows for a team of 15 employees, ensuring timely task execution, adherence to protocols, and consistent performance monitoring.</li>
<li>Maintain accurate records and documentation related to property intake, detainee processing, transportation, and deportation; verify and audit files to ensure regulatory compliance, and data integrity.</li>
<li>Execute high-volume data entry (up to 8 hours per day), including the entry of case notes, customs documentation, custody logs, and internal reports into secure federal databases.</li>
<li>Develop, review, and edit administrative reports and forms for internal use and government audits; ensure completeness, accuracy, and policy alignment.</li>
<li>Serve as the primary liaison between facility staff, supervisors, and stakeholders; facilitate clear, professional communication, and documentation flow across departments.</li>
<li>Identified discrepancies in data entries and corrected them accordingly.</li>
<li>Oversee inventory control processes, including the secure receipt, tracking, and storage of personal property, using standardized procedures and government tracking systems.</li>
<li>Conduct routine audits and quality control reviews to ensure that administrative practices meet federal operational standards.</li>
<li>Apply sound judgment to evaluate options, solve problems, and make informed recommendations on administrative and operational matters, contributing to efficient workflow management, and compliance with agency standards.</li>
<li>Assist in developing and revising privacy and security policies concerning Personally Identifiable Information (PII); identify potential compliance risks, and recommend solutions.</li>
<li>Coordinate logistics for detainee transportation to court and medical appointments, manage schedules, and track movement through detailed administrative planning.</li>
<li>Conduct roll calls, and ensure accountability through diligent documentation, system updates, and status reporting.</li>
</ul>
<p>Supervisor: Scott Jackson (949) 456-2706.</p>
<p>Permission to contact: Yes.</p> at ProTech USA LLC, Government Contracting
ul liWorking as part of the Corporate IT Team for a US based clients of Incedo Inc./li liFirst and Second Level Support in Windows and VMware environments./li liHands on experience of managing Incidents and Requests using ITSM tool./li liProviding desktop support to employees by implementing ITIL concepts in person and using remote tools./li liCoordinating with Users and Coworkers remotely over Calls/MS Teams/E-mails by applying effective communication and proper documentation of the work in a ticket./li liWorking on MS Active directory to apply group policies, password reset and directory management and for frequent user account lockout issues in a timely manner./li liAdhering to the pre-defined SLA's set for Resolution/Response of Incidents and Service Requests./li liRespond to outages both during normal business hours and after hours on a need basis (on-call support)./li liVulnerability and Patch management along with VM Backup./li liInfrastructure Monitoring and Resolution of Alerts generated by IT Devices./li/ul at Incedo Inc.ul liWorking as part of the Corporate IT Team for a US based clients of Incedo Inc./li liFirst and Second Level Support in Windows and VMware environments./li liHands on experience of managing Incidents and Requests using ITSM tool./li liProviding desktop support to employees by implementing ITIL concepts in person and using remote tools./li liCoordinating with Users and Coworkers remotely over Calls/MS Teams/E-mails by applying effective communication and proper documentation of the work in a ticket./li liWorking on MS Active directory to apply group policies, password reset and directory management and for frequent user account lockout issues in a timely manner./li liAdhering to the pre-defined SLA's set for Resolution/Response of Incidents and Service Requests./li liRespond to outages both during normal business hours and after hours on a need basis (on-call support)./li liVulnerability and Patch management along with VM Backup./li liInfrastructure Monitoring and Resolution of Alerts generated by IT Devices./li/ul at Incedo Inc.