Danielle Mckay Email & Phone Number

Remote

Grand Blanc, Michigan

-Managed case load of 200+ patients, monitored and updated charts with prior authorization requirements and determinations, completed chart reviews for ongoing skilled needs, submitted clinical documentation to providers based on medical guidelines -Oversaw hospice authorizations and IV contracts in addition to home care authorizations for eight health insurance providers-Maintained expertise in eligibility benefits, medical policy, and prior authorization requirements of multiple insurance providers-Worked closely with insurance case managers and utilization management staff, providing the necessary supporting documentation to meet clinical guidelines and medical necessity for each insurance payer-Completed clinical reviews based on InterQual Criteria as necessary -Worked with IT to create reports to locate gaps in authorization coverage-Decreased potential revenue loss by management and utilization of multiple reports-Collaborated with multiple disciplines and departments, internally and externally Identified areas for improved process efficiency and customer service -Contributed to process improvement teams to identified areas for improved efficiency and customer service, and assisted in implementing new processes-Organized and set up appeal process to reduce risk of revenue loss-Performed and provided clinical support to billing and claims departments for clinical appeals-Oriented, mentored, and educated staff in multiple departments, including navigation of computer systems with internal and external resources-Performed chart audits to increase quality performance and quality improvement measures

Grand Blanc, Michigan

-Processed referrals for home care and hospice services of five Michigan locations, reviewing and disbursing to local teams -Collaborated with liaisons form St. Mary's and St. Joseph's to increase market presence within these locations -Assisted in managing customer service representatives with referral information and electronic data entry-Educated new intake employees, including customer service representatives and registered nurses-Contributed to multiple process improvement teams during major company transitions and a statewide merger -Piloted new processes on numerous occasions during vital changes

Grand Blanc, Michigan

-Assessed patients’ physical and psychosocial statuses, developing individualized care plans -Educated patients and families on disease processes, treatments, safety, and medication management-Made referrals to assist patient and family in meeting personal care, functional, psychosocial, and community needs-Consulted with physicians on patient status, progress, and care plan -Participated in the development of a CHF pilot program

Grand Blanc, Michigan

-Prepared patients for procedures related to major and minor cardiovascular and respiratory conditions -Instructed patients and family about medications, wound care, follow up, and signs of worsening conditions-Educated patients in healthy lifestyle alterations