Elizabeth McConnell

• Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
• Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
• Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
• Submitted cases for criteria failures and helped facilitate resolutions and approvals.
• Served as a vital liaison between patients, healthcare providers, and insurance companies, fostering effective communication and coordination among all parties involved in the care process.
• Streamlined the case management process by effectively prioritizing high-risk cases for timely intervention and followup.
• Evaluated patient histories, complaints, and current symptoms.
• Proficient with InterQual, Medicare, Medi-Cal, and Commercial medical criteria.

• Aided physicians in conducting thorough physical examinations, providing essential support during clinical decision-making processes.
• Contributed to a positive work environment by collaborating with interdisciplinary healthcare teams.
• Administered IV fluids and SQ or IM medications, inserted IVs, and performed catheterizations.
• Gathered lab specimens and ordered testing to diagnose patients.
• Answered incoming phone calls from patients to provide basic assistance and triage medical concerns.
• Coordinated patient transfers to other facilities.
• Mentored new LVN staff members to ensure proper training and integration into the clinic''s workflow, promoting a cohesive team environment.
• Managed all patient prior authorizations, denials and referrals.

• Reviewed clinical documentation for prior authorization of surgical procedures, pharmaceuticals, treatments and testing.
• Utilized InterQual, Medicare, Aetna, BCBS, and Anthem criteria to determine medical necessity.
• Executed daily tasks with accuracy and efficiency.
• Maintained confidentiality of patient records by adhering to document protocols.
• Facilitated communication between patients and internal departments for seamless operations.
• Applied administrative expertise to clarify procedures and services for patients.
• Provided clear explanations to assist clients in understanding hospital policies.
• Employed critical thinking to analyze problems and evaluate effective solutions.

• Managed treatments for diverse wound types while assisting with various medical procedures.
• Educated patients and caregivers about diagnoses, treatment options, and self-management techniques.
• Collected biological samples for lab tests to facilitate accurate diagnosis.
• Input vital statistics, medical histories, and symptoms as part of intake procedure.
• Performed monitoring of patients during hyperbaric oxygen therapy sessions.
• Supported vascular procedures such as venous ablations, phlebectomy, and sclerotherapy.
• Rapidly onboarded for Emergency Department, providing assistance in ER for 2.5 months during Covid-19 redeployment.
• Ensured documentation of complete patient information to enhance care quality.

Educated clients, patients, and caregivers on medical diagnoses and treatment options.

• Collected biological samples for laboratory tests, specializing in difficult venipuncture.
• Managed patient pharmacy refills, prior authorizations, and referrals efficiently.
• Provided treatments and assisted with various medical procedures.
• Input medical histories, symptoms, and vital statistics during intake process.
• Guided patients in chronic disease self-management and wound care techniques.