Manage pre-authorization process for UHC and Humana Medicare Advantage members across multiple states· Review hospital clinical documentation and use clinical judgement and Medicare guidelines to determine post-acute medical necessity· Meet determination deadlines· Assign ICD-10 codes for primary diagnosis driving post-acute needs· Contact providers via phone or portal to request additional information, educate on appropriateness for skilled nursing or inpatient rehabilitation admission, and discuss member’s social supports and discharge plans· Maintain HIPAA privacy with every phone call and document review· Summarize available information to write clinical impression of member’s course of care· Submit authorizations for Medical Director review when appropriate· Communicate with appeals/denials coordinators and answer inquiries from providers regarding denied services· Manage incoming calls from providers and physicians and provide exceptional customer service· Navigate technical systems and proprietary software· Proficient in Microsoft Office suite· Present case studies and contribute to discussion with full team of clinical coordinators and physicians· Participate in ongoing internal education as well as continuing education to maintain licensure· Precept and mentor new colleagues

Evaluation and treatment of long-term care, assisted living, and short-term rehabilitation residents. Provision of physical therapy at the same facility for 8 years under two different contracted companies.· Review medical records to retrieve needed data prior to evaluation and treatment· Plan evidence-based treatments for geriatric patients with neurological, cardiopulmonary, and orthopedic conditions as well as general medical conditions and deconditioning· Research new approaches for challenging cases· Provide education and motivation to patients· Collaborate with multidisciplinary team for discharge planning· Complete home assessments when needed prior to discharge to home· Develop maintenance programs where appropriate· Supervise physical therapy assistant and restorative nursing aide

Physical Therapist at a small rural clinic serving a wide range of settings including acute care, skilled nursing, adult and pediatric home care, and schools.· Developed flexibility in order to serve a variety of locations and populations every day while maintaining multiple documentation styles and systems· Worked with a great deal of autonomy in the field, creating personal daily schedule traveling between several rural counties· Communicated effectively with nurses, teachers, paraprofessionals, and physicians via phone or in person