Greetings!
Trust all is well at your end.
Hi, ----------- here, I am currently the lead for a team of Utilization Management Nurses; I do both management and production work. Our team focuses on clinical review, case presentation and acquisition of authorization for a US healthcare facility that caters to mainly SUD clients with or without chronic and acute medical conditions.
As the lead, I make sure my team is calibrated to do extensive clinical reviews, guided with clinical judgement, to determine that our clients are able to utilize their benefits as needed and are receiving appropriate level of care management. Also, I keep track of caseload per insurance to ensure all current admissions are up to date in terms of coverage.
As a Utilization Management Nurse (ASAM-certified), I review cases and charts using EMR (WellSky) on a daily base and collaborate not only internally interdepartmentally but also externally with insurance companies. I conduct daily case presentations to insurance companies to coordinate our members clinical presentation which in turn reinforces extension requests and authorize members more time in treatment.
Additionally, I am Registered Nurse in the Philippines (BSN and pending USRN). I have experience in the clinical area, mainly in the OR-DR and ER but majority of my healthcare experience is when worked as a Medical Claims Adjudicator in a medical insurance company in Dubai, UAE. I audit claims using ICD, CPT and HCPCS codes, and approve coverage & benefits, or deny medical inconsistencies as needed. And after just 7 months, I got promoted to become an International Claims Manager. I was head of claims audit and adjudication, along side with doctors and co-managers, for our international clients. I ran my team with weekly deep dive case analyses to reinforce coordination and calibration.
Also, I have been a Project Lead and have been managing and directing multiple brands for the past 4-5 years, and I am offering my expertise, paired with accountability, to both start-up and existing businesses to produce reach, revenue, and mileage.
Trust all these find you well and fit, and hoping to be able to chat with you soon and get the chance to show the variety of support, and the partnership I could offer you and your company. Kindly reach me via Skype:---------------------- or send me an email to the same handle.
Thank you and with best regards,Emil
