Amanda Grignon

• Provide support to both Utilization Management (UM) and Case Management (CM) teams by reviewing relevant clinical information in connection with concurrent reviews and new authorization requests.
• Identify and introduce members who may benefit from enrollment in diagnosis-specific case management programs, ensuring appropriate care coordination and follow-up.
• Create Quick References Guides for trainings.
• Train and mentor new hires on company systems, policies, and procedures.
• Learn and acclimate to new systems as company transitioned to new technologies.
• Maintain and manage claims systems documentation to track and resolve discrepancies in claim dates.
• Investigate root causes of claim data issues and coordinate follow-up actions with clinical staff.
• Assign cases to nurses and monitor progress through resolution using Excel-based tracking systems.
• Create and process inpatient and outpatient prior authorization cases utilizing AUMI and ACMP systems.
• Identify appropriate case manager nurses and distribute cases accordingly to ensure timely review.
• Manage and review incoming faxes via MACESS and ACMP systems; evaluate for potential HIPAA violations and ensure patient data integrity.
• Determine request type (new authorization vs. concurrent review) and take appropriate action:
• Create new cases for prior authorizations; Attach concurrent reviews to existing cases.
• Perform case validation for inpatient cases received through Availity, ensuring provider and facility network status accuracy.
• Update case statuses from "Incomplete" to "Pending – Awaiting Review" after verification.
• Manage discharge tracking using the Beacon report:
• Identify recent discharges from northern state facilities.
• Contact facility medical records or case management departments to confirm discharge and disposition.
• Record discharge details in patient case files to ensure complete and up-to-date documentation.

• For the Transplant Department, verify member eligibility for additional benefits related to the transplant process, including lodging, travel, and ancillary support services.
• Send tailored educational materials to members, as requested by case managers, to support informed decision-making and care. planning.
• For the Maternity Department identify and refer eligible members to the Expectant Mothers Program, supporting improved maternal outcomes.
• Fulfill case manager requests by distributing educational resources to expectant mothers.
• For the Neonatal Intensive Care Unit (NICU) Department, contact parents of NICU patients to facilitate case management services and support resources.
• Create and maintain tracking sheets and case files for Synagis (RSV prevention) requests,documenting approvals or denials for case manager review.

• Provided comprehensive administrative support using Microsoft Office Suite, ensuring smooth daily operations across the department.
• Maintained attendance and PTO records for nursing staff and coordinated paycheck distribution.
• Managed office supply orders to support efficiency and uninterrupted workflow.
• Scheduled meetings and coordinated travel logistics for Directors and Vice Presidents within the National Accounts Unit.
• Sorted and distributed interdepartmental mail promptly and accurately.
• Drafted, prepared, and distributed hundreds of standardized form letters daily with precision and consistency.

Providing front office support in a fast-paced healthcare facility

• Greeted and checked in patients
• Verified insurance coverage and demographic information to ensure proper billing
• Collected co-pays
• Schedule new and follow-up appointments
• Answered multi line phone
• Updated medical records in compliance with organizational policies and privacy standards
• Managed and completed essential paperwork, including FMLA and workers’ compensation forms, and scheduled workers’ compensation depositions when applicable.
• Streamlined communication between patients and healthcare providers, ensuring timely responses to inquiries and concerns.
• Trained new staff members on office procedures and protocols, ensuring consistency in patient care delivery.