Shakira Wright Email & Phone Number

United States

● Evaluated severity of illness and intensity of service of members needs at time of admission utilizing approve criteria.● Obtained the necessary information to assess member's clinical condition, identify ongoing clinical care needs and ensure that members receive services in the most optimal setting to effectively meet their needs.● Collaborated with physician and hospital personnel to facilitate and coordinate care needs across the continuum of care.● Performed concurrent reviews on all inpatient, and facilities.● Monitored all utilization reports to assure compliance with reporting and turnaround times.● Addressed care issues with Director of Care Management and Chief Medical Officer/MedicalDirector as appropriate.● Communicated to facility any pre-arranged discharge planning.● Demonstrated effective communication methods and skills, using lines of authorityappropriately.● Established a relationship with providers in order to determine/provide needed services tomembers.● Acted as liaison and member advocate between the member/family, physician andfacilities/agencies.● Maintained accurate record of concurrent activities.● Knowledgeable in InterQual.

● Performed pre-authorization for home health services, diagnostic tests, surgical service/procedures, durable medical equipment, and rehabilitation.● Performed prior authorization reviews according to InterQual Criteria, Medicare Guidelines/CMS, established protocols and nursing judgment to determine the medical appropriateness of requested treatment.● Collaborate with Medical Director Reviewer for complicated cases and follow up resolutions of referrals that did not meet InterQual.● Manage care coordination of client panel of high-risk members (referrals, prior authorization, vendor management) throughout the care continuum, (acute, post-acute, discharge/transitions of care)● Monitor cross-departmental communications and ensure team is aware of timely and important updates● Provide accurate and complete documentation with rationale used to approve request.● Collaborate with various staff within provider networks and case management teamcoordinate patient care.● Demonstrated proficiency in word processing, spreadsheet, database, and emailapplications.● Proficient in navigating between multiple systems with dual monitors.● Organized and prioritize cases based on level or urgency which consist of urgent, dischargeplanning, standard, and retroactive.● Sufficient in executing health plan inquiries and auth requests in a timely manner.

United States

● Interview, hire, train, support, and develop all clinical and non-clinical staff.● Supervise all day-to-day activities to ensure an efficient and timely triage process is achieved with admission, existing patients and discharge.● Supervise appropriate patient care, guidelines and policies.● Supervise adherence and compliance to all education, quality, workforce management, customer service, and operational standards.● Oversee and provide education to clinical and non-clinical staff with collaboration with medical professional.● Audit data integrity to ensure a clean billable patient record.● Support and provide knowledge to the training programs that includes both clinical and non-clinical.● Identify emergent and urgent patient care following guidelines and policies and getting approval for additional care from a physician and/or medical director.● Provide prevention and intervention for multiple comorbidities by listening and performing an assessment. ● Coordinates care for patient and cooperates in interdisciplinary team meetings.● Provides clinical assessment and intervention utilizing the nursing process and triage protocols.● Collaborate with the attending physicians, case managers, medical directors and administrators electronically and telephonically to coordinate patient care.● Document interactions with physician, medical director, case manager and vendors in the client’s record to include the assessment, plan of care, and any actions and interventions and resolution of each client/family interaction.● Conduct admission and discharge planning.● Proficient in customer conflict resolution and crisis management.● Coordinates all service including client and family education, dispatching of interdisciplinary visits, and coordination of services with resources and external vendors.

United States

● Managed adult and pediatric hospice patients● Provides an appropriate, comprehensive and responsive plan of care.● Provide prevention and intervention for multiple comorbidities by listening and● performing an assessment● Assess member’s physical, environmental and psycho-social health issues and work incollaboration with a multi-disciplinary team, employing a variety of strategies/techniques tomanage appropriately and provide timely interventions.● Coordinates care for patient and cooperates in interdisciplinary team meetings.● Provides clinical assessment and intervention utilizing the nursing process and triageprotocols.● Collaborate with the attending physicians, case managers, medical directors andadministrators electronically and telephonically to coordinate patient care.● Document interactions with physician, medical director, case manager and vendors in theclient’s record to include the assessment, plan of care, and any actions and interventions andresolution of each client/family interaction.● Instruct staff and document appropriate use of medications, home equipment and supplies.● Conduct admission and discharge planning.● Proficient in customer conflict resolution and crisis management.● Coordinates all service including client and family education, dispatching ofinterdisciplinary visits, and coordination of services with resources and external vendors.● Provide information and educate co-workers on how to complete each task sufficiently.