Joyce Arena Email and Phone Number

Maintained accurate documentation on all cases, ensuring compliance with regulations andconfidentiality requirements.Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessaryinterventions.Monitored ongoing cases closely, adjusting case management strategies as needed based onevolving circumstances or new information.Educated clients on available programs, benefits, and services, empowering them to makeinformed decisions about their care needs.Reduced healthcare costs through efficient utilization of resources and identification of unnecessarytreatments or procedures.Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.Evaluated medical guidelines and benefit coverage to determine appropriateness of services.Performed prior authorization review of services requiring notification.Minimized financial risk associated with denials or payment discrepancies through diligentvalidation of medical necessity prior to service provision.Demonstrated commitment to ethical practice by upholding patient confidentiality and advocatingfor individual rights in all interactions with stakeholders.

Patient & Family Resources, Case ManagementAssess and review patients in MHS North Tower for discharge planning and integrated servicesCommunicate & collaborate with physicians, members of health team, patients, and familyCommunicate with payers to obtain insurance authorization for reimbursement of servicesCommunicate effectively with clinical team to manage patient needsDirect team in processing of orders, referrals, and medical record requestsResponsible for review and submission of authorization requests, tracks denials and determinesappropriate next steps.

• Responsible for coordination of health care decisions by using a systematic approach to assure treatment plans that improve quality and outcomes, coordination of care across thecontinuum for complex medical patient case management • Collaborates with healthcare team members to facilitate care across the continuum and optimize clinical and financial outcomes• Promotion of cost-effective care within the allotted time frame assuring payments of hospital-based services meeting patient related utilization management criteria• Implementation of safe and appropriate discharge plans assess the social work needs of the patient and provide social work interventions as part of the discharge planning process• Clinical interventions/ discharge and care management planning, fiscal management, and payer referral management• EPIC• Allscripts• Internet Explorer

• Care Management Advocate for members assessing, planning, and implementing care for Insurance review• Coordinating with members and care givers to evaluate the medical needs of the member to facilitate the member’s overall wellness for Insurance company • Extensive record review, interaction with physicians, health information professionals and nursing staff for Insurance company • JIRA• ROSCO• AERIAL MEDECISION• InterQual MCG

• Patient & Family Resources, Case Management • Assess and review patients in the SICU for discharge planning and integrated services. • Communicate & collaborate with physicians, members of the health team, patients and family requiring a transfer to stepdown facility, home care, home infusion, and durable medical equipment.• Communicate with payers to obtain insurance authorization for reimbursement of services. • EPIC• Allscripts

• Pre-admit Anesthesia Clinic Registered Nurse (North, South, Tradition hospital, & surgery centers)Working with Anesthesiologists meeting with surgeons, creating a department to optimize surgical patients prior to surgery • Self-directed with astute judgment skills • High level of personal accountability and strong work ethics• Interviewing patients over the phone using Anesthesiologist's guidelines• Document patient information obtained from phone interviews • Assess need for, then order, obtain, and interpreted appropriate tests and clearances• Chart and review to evaluate and optimize patient's care prior to a surgery to avoid same day cancelations.• EPIC

• Developed patient care plans• Performed Nursing assessment and developed, implemented, and evaluated plan of care in conjunction with the Physician, patient and caregivers per policy and procedures• Expresses verbal and written communication in a clear, positive, and cooperative manner• Implements a plan of care and instructs the patient/caregiver on signs/symptoms of complications and home management related to the patient's disease process

• Hospice Admission department Registered Nurse • Communicated with physician and obtained appropriate medical orders. • Communicated with interdisciplinary team. • Coordinated equipment, medications, home health aide and other services needed for optimum care and safety for hospice patients.

emergency room ,Also worked Per Diem at the stress test, MRI, admitting and recovery out-patient surgery site for MMHS

assist in oral surgery and all aspects of dental care. dental cleaning of pediatric patient, prep and care of equpment needed for all procedures

sales and care of all products in store. customer care.