Alejandra Orquiz
Portland
Summary
Dynamic healthcare leader with extensive experience at Universal Health Services, excelling in compliance monitoring and quality assurance. Proven track record in optimizing resource allocation and enhancing communication across departments, resulting in improved patient care outcomes. Adept at policy implementation and fostering collaboration among multidisciplinary teams to drive operational excellence.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Associate Administrator
Cedar Hills Hospital
Portland
03.2025 - Current
- Coordinated cross-functional teams to achieve project milestones and objectives.
- Established quality control measures to maintain high service standards throughout operations.
- Served as strategic advisor and functional expert on critical strategic and operational matters.
- Led the organizational development changes, enabling organization to better respond and adapt to industry and market changes.
- Developed operational policies and processes, guaranteeing staff maintained compliance with federal, state and local laws and regulations.
Director of Utilization Management
Cedar Hills Hospital
Portland
12.2021 - Current
- Supervised utilization management staff to ensure compliance with policies and procedures.
- Collaborated with healthcare providers to review patient treatment plans and resources.
- Analyzed utilization data to identify trends and recommend improvements in processes.
- Implemented quality assurance measures to enhance service delivery across the department.
- Facilitated communication between departments to streamline patient care processes.
- Monitored performance metrics related to utilization management outcomes such as length of stay and episode duration, denied days, and readmission rates.
Director of Intake and Front Desk
Cedar Hills Hospital
Portland
06.2024 - 01.2025
- Managed patient intake processes to ensure smooth admissions at Cedar Hills Hospital.
- Analyzed intake data to identify areas for improvement in workflow operations.
- Ensured compliance with applicable laws and regulations governing intake processes.
- Coordinated communication between internal staff, external partners, and clients regarding status updates on intake requests.
- Oversaw scheduling for patient appointments, optimizing resource allocation effectively.
Lead Utilization Review Manager
Georgetown Behavioral Health Institute
01.2021 - 12.2021
- Instituted systems, processes, and policies to enhance communication workflow and staff performance.
- Managed three levels of care, overseeing 95 patient cases and coordinating with therapists, psychiatrists, and nurses.
- Collaborated with the clinical director to ensure fair substance abuse treatment in a trauma-informed setting.
- Engaged daily in advocacy practices by advising patient treatment teams and insurance providers.
- Facilitated client clinical care advocacy to track progress effectively.
Senior Utilization Review Manager
Promises Behavioral Health
06.2019 - 12.2021
- Led daily advocacy practices via advising and collaborating with the patient treatment team and insurance provider.
- Instituted new systems, processes, and policies to improve communication, workflow, and employee performance & satisfaction.
- Managed 3 levels of care with up to 95 patient cases and obtained pre-certifications and additional coverage based on medical necessity criteria.
- Collaborated with 5 therapists, 2 psychiatrists, 1 nurse practitioner, and up to 10 nurses and worked closely to ensure quality documentation and medical necessity.
- Worked closely with the clinical director and other leadership to ensure compliance and appropriate levels of care for substance abuse treatment in a trauma-informed environment.
- Advocated for client’s clinical care and ensured appropriate progress.
Education
Doctor of Social Work -
Tulane University
New Orleans, LA12-2024
Master of Social Work -
Texas State University
San Marcos, TX05-2019
Bachelor of Social Work -
New Mexico State University
Las Cruces, NM05-2016
Skills
- Compliance monitoring
- Quality assurance
- Resource optimization
- Effective communication
- Problem solving
- Policy implementation
- Operations oversight
- Documentation and reporting
Certification
Licensed Master Social Worker (LMSW) in Texas
Timeline
Associate Administrator
Cedar Hills Hospital
03.2025 - Current
Director of Intake and Front Desk
Cedar Hills Hospital
06.2024 - 01.2025
Director of Utilization Management
Cedar Hills Hospital
12.2021 - Current
Lead Utilization Review Manager
Georgetown Behavioral Health Institute
01.2021 - 12.2021
Senior Utilization Review Manager
Promises Behavioral Health
06.2019 - 12.2021
Doctor of Social Work -
Tulane University
Master of Social Work -
Texas State University
Bachelor of Social Work -
New Mexico State University