Alicia Temple
Cathedral City,United States
Summary
Dynamic LVN with over 20 years of experience providing expertise in utilization review seeking a role in healthcare administration to optimize patient care and healthcare resource utilization. Highly-motivated employee with desire to take on new challenges. Strong worth ethic, adaptability and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.
Overview
20
20
years of professional experience
Work History
Concurrent Review Nurse
Hills Physicians Medical Group
07.2009 - 08.2020
- Led multifaceted concurrent review processes in fast-paced environments
- Cultivated collaborative team dynamics and provided comprehensive training
- Demonstrated adeptness in managing concurrent reviews across various healthcare settings.
Appeals Specialist
Lumetra Ca 010
01.2004 - 08.2008
- Facilitated expedited appeals and concurrent reviews for Medicare enrollees
- Managed medical records review process and prepared determination letters
- Provided technical expertise and acted as a resource for staff and beneficiaries.
Patient Care Coordinator
Sun Bridge La Mariposa
04.2000 - 01.2004
- Developed individualized care plans to enhance residents' well-being
- Conducted comprehensive assessments and facilitated family care conferences
- Ensured smooth transitions between care levels and improved discharge planning processes.
Education
Vocational Nursing License -
Hayward Regional Occupational Center
Skills
- Clinical Review
- Business Development
- Case Management
- Discharge Planning
- Workflow Management
- Project Management
- Risk Analysis
- Customer Service & Relationship Management
- Written Communication
- Quick Problem Resolution & Decision Making
- Cross-Functional Business Acumen
- Utilization Review
- Interdisciplinary Collaboration
- Medicaid Knowledge
- HIPAA Compliance
- Healthcare Regulations
- Care Coordination
- Microsoft Office
- Critical Thinking
Accomplishments
- Reduced communication gaps by 30% through effective information exchange.
- Lowered re-admissions of high-risk patients by 20% through proactive care management.
- Facilitated necessary referrals to supportive programs per Health Plan Guidelines.
Additional Responsibilities
- Maintained Medicare certifications and conducted data entry for PPS RUG levels.
- Participated in weekly Rehab and IDT meetings and completed audits.
- Scheduled resident outpatient appointments and managed staff assignments.
- Resolved staffing issues and assisted in training and development initiatives.
Timeline
Concurrent Review Nurse
Hills Physicians Medical Group
07.2009 - 08.2020
Appeals Specialist
Lumetra Ca 010
01.2004 - 08.2008
Patient Care Coordinator
Sun Bridge La Mariposa
04.2000 - 01.2004
Vocational Nursing License -
Hayward Regional Occupational Center
Similar Profiles
Katelyn LeBlancKatelyn LeBlanc
Nurse Educator/Clinical Staff Development at Mass General Brigham Medical Group - North Shore Physicians GroupNurse Educator/Clinical Staff Development at Mass General Brigham Medical Group - North Shore Physicians Group
Marlenne Griselda Limas MonjesMarlenne Griselda Limas Monjes
Access Associate Senior at University Physicians Group/ UVA Medical CenterAccess Associate Senior at University Physicians Group/ UVA Medical Center
MARIA L. ARROZAMARIA L. ARROZA
LVN, Authorization Denial Nurse at Health Physicians Medical GroupLVN, Authorization Denial Nurse at Health Physicians Medical Group
Patricia Cortez-LorenzoPatricia Cortez-Lorenzo
Customer Care Specialist at univar solutionsCustomer Care Specialist at univar solutions
Samantha Santana-FloresSamantha Santana-Flores
Barback / Busser at SaffronBarback / Busser at Saffron