Alena Deryabina Whaler

• Performed concurrent utilization reviews and first level determination approvals using evidenced based guidelines, policies and nationally recognized clinal criteria for Medicare.
• Conduced clinical review of claims for medical necessity, coding accuracy, medical policy compliance and contract compliance.
• Ensured discharge planning at levels of care appropriate for the members needs and acuity and determine post-acute needs of member including levels of care, durable medical equipment, and post service needs to ensure quality and cost appropriate discharge planning
• Prepared and present cases to Medical Director (MD) for medical director oversight and necessity determination and communicate determinations to providers and/or members to in compliance with state, federal and accreditation requirements.
• Developed and reviewed member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards and identify potential quality of care issues, service or treatment delays and intervenes or as clinically appropriate
• Collaborated with Case Management on acute inpatient issues that impact discharge.
• Maintained quality and productivity metrics for all casework.
• Ensured workspace adhered to HIPAA compliance standards.

• Performed assessments, identification of specific needs, and social service interventions/referrals while in an acute setting.
• Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
• Advocated for patients by communicating care preferences to providers, verifying interventions met treatment goals and identifying insurance coverage limitation.
• Collaborated with an interdisciplinary healthcare team to ensure continuity of care.
• Implemented treatment programs, appropriate services, and arranged necessary resources/transportation to patients.
• Coordinated individualized discharge plans to manage safe transition back into community and home environments.
• Coordinated acute/non-acute patient transfers to appropriate facilities such higher level of care.
• Performed Utilization Review: compiled and reviewed medical information and insurance coverage.
• Established and maintained efficient methods of ensuring the medical necessity and appropriateness of hospital admissions.
• Performed concurrent reviews of patients to ensure that extended stays are medically justified and are so documented in patient's medical records.
• Reviewed the clinical needs of patients to ensure consistency with InterQual criteria and hospital services.

• Delivered patient care through the nursing process of assessment, planning, implementing, and evaluation.
• Communicated all pertinent information and interventions to physicians.
• Accessed implanted ports, maintained and obtained blood from central venous lines.
• Provided treatment, administered chemo medications, IV medications, blood and blood products.
• Cared for numerous of tubes/lines/drains such as Jackson-Pratt, Negative Pressure Wound Therapy, NG tubes, all various catheters, stomas, nephrostomy, continuous bladder irrigation, ect.
• Served as patient/family advocate, educator, and emotional support.
• Managed high dose narcotic administration and provided end of life care and support for dying patients and families.
• Provided a safe and patient-centered environment.
• EPIC experienced.

• Gathered data relevant to the patient's individual needs and age group: vital signs, weight, medication profile, immunization record, allergies, chief complaint, ect.
• Performed patient assessments/reassessments on a regular basis in accordance with established policy.
• Implemented plan of care as developed by the providers and communicated changes in patient's status to enhance treatment strategies.
• Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing outcomes.
• Provided individualized education for the patient, family, and or caregiver throughout the - of care.
• Administered oral, intramuscular, and intravenous medications to patients and monitored responses. Documented patients charts by recording food and fluid output and intake.
• Delivered quality care and comfort to patients with heart failure, pulmonary hypertension, pulmonary embolisms and end-stage renal disease.
• Monitored and managed various treatment and care interventions, including IV administrations, blood transfusions, wound and ostomy care and catheter insertion.
• Adapted to a rapidly changing work environment, new facility protocols paired with split-second decision-making skills ensuring continuity in care.
• Provided inpatient nursing care to intensive care patients receiving treatment on a COVID-19 unit.

EOA

• Responsible for overseeing all aspects of the event.
• Scheduling, staffing, or facility issues.
• Managing customer request and issues.
• Ensuring proper protocols are followed such as proper PPE use, hand hygiene, social distancing, specimens collections
• Maintaining an efficient and positive work environment for staff and residents.
• Following chain of command to unsure proper success of the event.

CP

• Front line testing individuals with exposure to and possible symptomology related to COVID-19.
• Supervising and Conducting specimens collections.
• Temperature checks for all event staff prior to start of the event.
• Oversight of any event staff reporting onset of symptoms or fever during event participation.
• Supervision and guidance regarding PPE.

• Oversaw all aspects of the office, including directing, supervising, and coordinating.
• Administered recruiting, hiring, training of new employees, and coordinated student internships.
• Performed HR duties related to employee relations, payroll, benefits, licensing and contracts.
• Ensured compliance with OSHA and HIPPA regulations.
• Managed all business accounts, purchasing, inventory, and contract negotiations with vendors.
• Developed and implemented office policies and procedures.
• Oversaw construction and renovation projects.
• Managed company security system, phone system, and liaise with building management.
• Managed social media accounts and coordinated IT projects.
• Performed all duties within the scope of practice of a Certified Medical Assistant.

• Upheld high standards of productivity and quality in all areas of operations.
• Worked closely with the store manager to maintain day-to-day operations.
• Supported office administrative needs with timely and knowledgeable clerical assistance to maximize team performance and efficiency.
• Supervised and trained customer service team members to provide exceptional service, driving retention and satisfaction.
• Streamlined efficiency, reduced labor hours and boosted profitability to optimize overall productivity.

License Number: 95226518

• Minor in Health Administration
• Vice President of CSU Chico Health Professional Associate Club (HPA)