Amanda Estrada-Haynie
Studio City
Summary
Results-driven Director of Nursing/Medical Review with 12 years of nursing management experience and over 30 years in healthcare. Skilled in implementing innovative solutions to boost productivity and operational efficiency. Recognized for fostering teamwork and adapting to changing business requirements to align with organizational objectives.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Director- Medical Review and Network services
Motion Picture Industry Pension and Health Plan
12.2016 - Current
- Implemented new narrow network (MP3), effective 1/1/2022
- Collaborate with Anthem Prudent buyer on contracting and cost analysis of Providers
- Collaborate with multiple provider and medical groups to coordinate care through the Motion Picture Industry
- Implemented training for both individual and large providers groups such as UCLA and Children’s Hospital Los Angeles
- Devised reports to indicate performance and trajectory of the new network
- Managed MP3 call center
- Registered Nurse, Medical Review Manager, Case Manager
- Handle claim reviews based on guidelines and medical necessity and resolve pre authorization medical claims
- Review for clinical appropriateness of Denials including denials for DX not valid to make sure the benefit does not need to change.
- Understand and utilize the Summary Plan Description to make medical determinations as necessary
- Supervision of staff members including, managers, clinical and administrative staff
- Recruit, hire, train and supervise department personnel as well as assist with performance reviews and monitoring Timekeeper.
- Responsible for cross training, performance reviews and overall staff activities.
- Review for appropriateness, requests for disability extensions, handicap dependent coverage, and disability retirements and break in service issues.
- Authorization of necessary medical services.
- Oversee, authorize and review Case Management services. Interact with the Case Managers for UCLA/MPTF and Anthem. Prospectively audit UM data for Participants who may be candidates for our Case Management services.
- Coordinate activities regarding Claims with Medical Consultants and Participants Service Center communications.
- Developed policies ensuring compliance with federal regulations and industry standards.
- Streamlined communication processes between stakeholders, improving operational efficiency.
- Mentored team members, fostering professional development and enhancing departmental performance.
- Analyzed data trends to inform decision-making and improve plan offerings.
- Collaborated with finance teams to manage budget allocations for health services effectively.
- Implemented technology solutions that increased member engagement and service accessibility.
- Assist with preparation of the Medical Review Department annual budget.
- Reviewing and updating the MRD Policy and Procedure manual annually.
- Assist in recommending and preparing benefit changes.
- Review and assist with Third Party Liability (TPL) and Workers’ Compensation inquiries.
- Serve as liaison for Participant’s, providers, Business Partners and the organizations various departments.
Nursing/Practice Manager, Ambulatory Care, WSHC/JSHC
University of California Los Angeles
06.2014 - 12.2016
- Ensures optimal clinical and non-clinical performance standards, patient flow and customer service, incorporating continuous quality improvement for the health center; integrates the services with the mission, vision and strategic goals of UCLA.
- Serves as the facility liaison with patients, businesses, hospitals, vendors, and other government entities and professional bodies
- Hires, supervises, trains, and coaches all health center clinical and non-clinical staff, guiding behaviors, providing direction, setting goals, and influencing accountability and outcomes. Conducts timely performance evaluations, addresses disciplinary action when indicated, and provides ongoing feedback and training to support staff professional development and obtain high quality and productivity.
- Ensures optimal physician and non-physician staffing to accomplish objectives.
- Regularly monitors all aspects of revenue cycle to maximize reimbursement. Prepares, monitors, and assumes ownership of operational budgets and financial performance of assigned operations. Forecasts needs for capital items, equipment, and maintenance and ensures adequate and financially feasible supply inventory.
- Monitors and arranges repairs regarding the maintenance, safety and security of the physical site and equipment.
- Develops department policies/procedures and ensures compliance.
- Collects, analyzes, and reports data relevant to operations, revenue cycle, and customer service.
- Oversees and participates in quality and risk management activities, developing action plans and sustaining improvements.
- Ensures ongoing preparation, readiness and compliance with regulatory agency standards.
- Ensures confidentiality of all personnel and patient information.
- Serves as on-site super-user for IT software operation and issues.
- Develops department policies/procedures and ensures compliance.
- Fosters a culture of teamwork, communication, and mutual respect consistent with UCLA values. Assumes responsibility for continued professional development, as well as contributing to the educational, supervisory, administrative, and systems improvements and research efforts for the UCLA organization.
Nursing Supervisor
Motion Picture and Television Fund
08.2012 - 06.2014
- Responsible for directly supervising 50 nurses and supervised nursing staff to ensure compliance with healthcare regulations and organizational standards.
- Developed and implemented training programs to enhance staff competencies and patient care quality.
- Coordinated patient care activities, optimizing workflow efficiency and resource allocation.
- Led interdisciplinary meetings to assess patient needs and establish effective care plans.
- Monitored performance metrics, identifying areas for improvement in nursing operations.
- Conducted regular evaluations of nursing protocols, ensuring adherence to best practices and safety guidelines.
- Mentored junior nurses, fostering professional development and enhancing team collaboration.
- Streamlined documentation processes, improving accuracy and reducing administrative workload for nursing staff.
- Promoted interdisciplinary collaboration by fostering strong relationships with physicians, therapists, and other healthcare professionals.
- Mentored new nursing staff members to promote adherence to established best practices and foster professional growth.
- Followed all HIPAA rules and regulations regarding patient confidentiality.
- Delegated tasks and provided leadership for [Number] nurses and support personnel.
- Discussed patient care and treatment with care team members to optimize intervention plans and care delivery.
- Contributed to positive team dynamics as an approachable supervisor who actively listened to concerns from both patients and nurses.
- Answered questions and addressed concerns from employees via email, phone and in person.
Education
Master of Science - Nursing Administration
University of Texas At Arlington (UTA)
Arlington, Texas03.2020
Bachelor of Science - Nursing
The University of Texas At Arlington
Arlington, TX05-2017
Associated in Nursing Degree - Nursing
Los Angeles Pierce College
Woodland Hills, California06.2012
Skills
- Relationship building
- Strategic planning
- Verbal and written communication
- Decision-making
- Program management
- Operations management
- Team management
- Creativity and innovation
- Strategies and goals
- Organizational development
- Goal setting
- Budget management
- Contract and vendor management
Certification
- Registered Nurse License # 825878, 2024-08
- Pursuing Board Certification Advanced Executive Nurse
Affiliations
- American Nurses Association (ANA), Member since 2012
- Case Management Society of America, Member since 2015
Timeline
Director- Medical Review and Network services
Motion Picture Industry Pension and Health Plan
12.2016 - Current
Nursing/Practice Manager, Ambulatory Care, WSHC/JSHC
University of California Los Angeles
06.2014 - 12.2016
Nursing Supervisor
Motion Picture and Television Fund
08.2012 - 06.2014
Associated in Nursing Degree - Nursing
Los Angeles Pierce College
Master of Science - Nursing Administration
University of Texas At Arlington (UTA)
Bachelor of Science - Nursing
The University of Texas At Arlington
Similar Profiles
Demetrius CookDemetrius Cook
Manager at Motion Picture Industry Pension & Health PlansManager at Motion Picture Industry Pension & Health Plans
Michele Shows MartinezMichele Shows Martinez
Administrative Assistant at Motion Picture IndustryAdministrative Assistant at Motion Picture Industry
STEVEN MARTINSTEVEN MARTIN
MEDICAL PRODUCTION COORDINATOR at Motion Picture and Television IndustryMEDICAL PRODUCTION COORDINATOR at Motion Picture and Television Industry
Lia SarkisyanLia Sarkisyan
Studio Assistant at Louiza BabouryanStudio Assistant at Louiza Babouryan
Daria NashenkoDaria Nashenko
Cannabis Cultivator at Seed JunkyCannabis Cultivator at Seed Junky