706 Aviation Way
Pomona, CA 91766
Job Objective Seeking a position with company in which to exercise my experience and training as an Utilization Manager.
Highlights of Qualifications:
- Huge experience in managing health care , managing clinical documents and developing and implementing various programs
- Exceptional knowledge of methods and various techniques of health care
- Huge knowledge of health plans and related processes
- Outstanding ability to provide optimal service in multiple health care facility
- Ability to work in coordination with medical staff
- Skilled to work on computer and resolve problems
- Remarkable oral and written communication skills
- Proficient n understanding all components of health care
- Familiarity in medical terminology and related contracts
Amerigroup, Pomona, CA
October 2008 – Present
- Reviewed acute service at site and on telephone as well.
- Planned pre admission of patients required and prepared post discharge care.
- Managed work in accordance to guidelines provided to validate medical work.
- Coordinated with manager and prepared census for various health care services.
- Maintained quality services with maximum utilization of available resources.
- Documented all policies in system according to time.
- Monitored Quality Improvement Process carried by members.
- Provided customer service to both internal and external customers.
AppleOne, Pomona, CA
August 2003 – September 2008
- Reviewed all patient information and recorded details of patient illness and resources utilized for services.
- Coordinated with physician and discharge staff and facilitated patient care and timely discharge.
- Managed vendors and provided external parties necessary information of facility to obtain necessary certificates.
- Assisted coding staff in documenting process such as patient condition, resource used and any medical emergency rendered.
- Evaluated all medical records and performed quality monitoring on required documents.
- Planned and assessed al patient discharge.
CVS Caremark, Pomona, CA
May 1998 – July 2003
- Reviewed all contracts and ensured benefit eligibility and authorized inpatient admission.
- Monitored cases and referred cases for clinical review and handled specialty care services.
- Coordinated between internal departments and medical management.
- Managed all queries by clients and assisted various in house departments.
- Trained new employees and subordinate staff in various functions.
- Evaluated all benefit programs for facility based treatment.
Bachelor’s Degree in Business
Wilmington College, Wilmington, OH