▸Mitigates and prevents complaints from being escalated to resolve in initial contact.▸Serves as the front-line resolution advocate on various member and/or provider inquiries, requests, or concerns▸Scheduling appointments▸Applies clinical knowledge to work with facilities and providers for carecoordination.▸Schedules transportation to and from multiple appointments for patients ▸Maintain confidentiality per HIPAA guidelines.▸Assist department with tracking and meeting performance standards. ▸Assist with updating training material and training new hires

▸Build relationships overseas for development of new customer relation management software. ▸Answer client complaints and questions ▸Build relationships with clients via webinars. ▸Host webinars and workshops weekly ▸Problem solve system/software issues. ▸Educating new and existing clients on customer relationship management tools ▸Implemented marketing to scale business to over 6 figures in less then 6 months▸Automated entire system▸Delegated all tasks to be completed by employees and put management in place to oversee the company.

▸Work with small and large developers to assign off market discounted scattered lots for new construction/investment purposes. ▸Heavily marketing in FL, but will soon be branching out to other regions of the USA.

▸Responsible for the review of clinical information via MCG/Interqual/ CMS ▸Guidelines for service requests received and render a medical necessity approval or recommended elevation for potential denial to the Medical Director. ▸Evaluate information concerning patient care and match those needs with available care options, consistent with CareCentrix guidelines and specific plan payer criteria. ▸Review referrals for medical necessity and determine approval or elevation to the Medical Director.▸Own the case from point of referral to the recommendation for denial, or approval decision.▸Aide in training the new hires from classroom, to floor, and being available via IM, phone, and email for any additional questions that may arise after training was complete.

▸Telephonically reviews medical information in order to determine the medical necessity of continued stay according to review standards. Determines whether treatments are consistent with member's diagnosis and appropriate level of care.▸Ensures that services provided to eligible members are within benefit plan and appropriate contracted providers are being utilized.▸Determines medical necessity and length of stay based on the consistent application of CMS criteria, Interqual criteria, and Clinical Coverage Guidelines and communicates with Medical ▸Directors for those reviews that fall outside of approvals.▸Assesses and coordinates simple discharge planning (short-term rehabilitation, homecare etc) with physicians, caregivers and ancillary providers to support the member's continuity of care needs.▸Interacts with facility discharge planners/utilization management team to coordinate medical treatment plan, and identifies opportunities for optimizing clinical outcomes through referrals to specialty care programs or an alternate level of care.▸Identifies members at high risk for complicated medical treatment plans, and/or repeat admissions potential and refers them to the appropriate case and disease management teams.▸Coordinates authorization and/or delivery of post-acute care services, including, but not limited to referrals to case and disease management, home health, medical equipment, skilled nursing facilities and other community based services.▸Identifies quality of care issues, and reports to appropriate health plan Quality department representative. Ability to follow and apply all necessary regulatory requirements for assigned market.▸Oversees the appropriate utilization management of services requested.▸Assists with implementation of healthcare initiatives in market.▸Assists in implementation of specific strategies that improve the quality and outcomes of care in market.

▸Multi-physician office providing both standard and alternative/integrative diagnosis and treatment across various diagnoses and ages▸Responsible for:▸Interdisciplinary collaboration with medical peers, management, and external vendors▸Tracking and ordering all back-office supplies and managing inventory▸Overseeing back-office operations▸Collecting patient specimens and performing IV administration, phlebotomy, and preparing patient-specific IV nutrient bags▸Reporting results to providers and patients▸Administering intramuscular (IM) and subcutaneous (SUBQ) injections▸Creating vaccination schedules and scheduling patient appointments▸Proficient in using e-MDs electronic health record (EHR) software▸Engaged in cost-benefit analysis for developing new programs and services▸Preparing patient charts for providers▸Handling preauthorizations with multiple insurance providers and policies▸Processing billing and collections▸Assessing risks and acuity levels in patient treatment