Jsa Healthcare Corporation - Director Resume Example

Emily Bell

XXXX XXXX XXXXX XXX, Palm Harbor, FL 34683

Ph: XXXXXXXXXXXX

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Professional Summary

Seasoned Utilization Manager with more than 17 years of experience in fast-paced clinical environment. Excellent verbal and written skills. Track record of achieving exceptional results in Utilization compliance and Disease Management compliance.

Skills

Detailed Oriented

Experience

Director, Affiliate Medical Management Jun 1997－Present JSA Healthcare Corporation － St. Petersburg, FL

Education of New Affiliate Providers
Monthly monitoring of Utilization Management costs for all Affiliated Providers and making recommendations for areas of improvement.
Liaison between Affiliate Providers and Health Plans
Assure compliance of Health Plan Delegation Policies
Quarterly and Annual reporting to Health Plans on Utilization statistics and Disease Management statistics
Assist Medical management team with daily review of hospitalized, LTAC, IRF, and SNF cases to facilitate appropriate discharge.
Assist Affiliate team with Medicare and Health plan coverage issues.
Review and analyze department activities and data to aid planning and risk management and to improve service utilization.
Participated in the Quality Management Oversite and Best Practices Committees

Other positions held at JSA:
Director of Medical Management:

Development of CM policies and processes
Instrumental in development and compliance of JSA Delegation policies and procedures, both Utilization Management and Disease Management Programs
Direct, supervise and evaluate work activities of Case Management and Disease Management staff.

Case Manager Apr 1995－May 1997 Harborside Healthcare － New Port Richey, FL

Monitor, evaluate, and record client progress with respect to treatment goals.

Assist clients in adhering to treatment plans, such as setting up appointments, arranging for transportation to appointments, or providing support.

Refer patient, client, or family to community resources for housing or treatment to assist in recovery from mental or physical illness, following through to ensure service efficacy.

Counsel or aid family members to assist them in understanding, dealing with, or supporting the client or patient.
Work closely with Health Plans determining need for continued skilled care and discharge planning needs

Education

Associate of Science : Nursing May 1984 St. Petersburg Jr College － St. Petersburg, FL

High School Diploma Jun 1982 Tarpon Springs High School － Tarpon Spring, FL

Additional Information

Completed Bullet Proof Manager in 2002
Completed manager University in 2011

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Resume Details

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                                        Previous Companies:
                                        JSA Healthcare Corporation
Harborside Healthcare

                                

                                        Previous Job Positions:
                                        Director
Affiliate Medical Management
Case Manager

                                

                                        Schools:
                                        St. Petersburg Jr College
Tarpon Springs High School

                                

                                        Level of Education:
                                        Associate of Science
High School Diploma

                                

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