Arnilda Panopio-Cabrera BSN, RN

• Educated patients and families on health care needs, conditions, and options.
• Demonstrated ability to work independently as well as collaboratively within a team environment.
• Conducted intake assessments with patients and relatives to gather case history.
• Advocated for patients by supporting and respecting basic rights, values, and beliefs.
• Monitored and managed various treatment and care interventions.
• Assessed, planned, implemented and evaluated nursing care for assigned patients.
• Provided emotional support to patients and their families during difficult times.
• Provided emotional support and counseling to patients and their families.
• Recorded patient condition, vital signs, recovery progress and medication side effects.
• Documented patient progress notes accurately and efficiently in the electronic medical record system.
• Maintained thorough, accurate and confidential documentation in electronic medical records.
• Administered medications and treatments, monitoring patients for reactions and side effects.
• Maintained a safe environment for all patients by adhering to infection control policies and procedures.
• Evaluated effectiveness of interventions through ongoing assessment of patient responses.
• Utilized critical thinking skills to assess clinical situations quickly and accurately.
• Updated charts throughout shifts with current, accurate information to maintain strict recordkeeping standards.
• Acted as patient advocate and implemented total patient care through team nursing process.
• Monitored vital signs, administered injections, and provided assistance with medical procedures.
• Monitored diet, physical activity, behaviors and other patient factors to assess conditions and adjust treatment plans.
• Observed strict safety measures, including checking medication dosages before administration to patients.
• Managed time effectively to ensure tasks were completed on schedule and deadlines were met.

Performs Utilization Management review in accordance with Federal and State mandated regulations.

Maintains compliance with regulatory changes affecting utilization management.

Perform prospective reviews for inpatient/outpatient services services/procedures in the course of work with different clients according to URAC standards and client requirements and/or policies.

Review UM requests for services against established clinical review criteria, referring cases not meeting criteria to a physician reviewer.

Adheres to Department of Labor, state and company UM timeframe requirements.

Coordinates physician reviewer referral as needed and follows up timely to obtain and deliver results.

Tracks status of all Utilization Management reviews in progress.

Releases UM determinations to stakeholders following client-established protocols.

Certifies reviews that meet clinical review criteria/guidelines.

Adheres to quality standards and state UM guidelines.

Maintains all required UM review documentation in the UM software in a timely manner.

Serves as first level contact for customer complaint resolution.

Responds to inbound telephone calls pertaining to UM reviews in a timely manner, following established client protocols.

Maintains confidentiality of all information, policies and procedures as required by the Health Insurance Portability and Accountability Act (HIPAA).

Manages assigned workload within established performance standards.

Support role by auditing assigned line of business, specifically:

In monitoring, reporting, and evaluating the accuracy of the process performed by agents.

Coaching and guiding the analysts to help them in the understanding of data, and recommending corrective action where required.

Initiating, planning, implementing and evaluating process improvements for establishing a cost effective and efficient process workflow ensuring quality.

Support role by auditing assigned line of business, specifically:

Reviews all process documentation and ensures quality standards are met

Utilizes tools for consistent quality audit review.

Utilizes tools to track the quality audit review results.

Identifies opportunities to improve department efficiencies based on quality statistics.

Works closely with Business Analysts to implement system improvements.

Serves as a back-up to other Operations and department employees.

Researches suggestions forwarded by staff and keeps items confidential, as needed.

Ability to maintain consistency in regard to department standards/procedures.

Keeps manager informed verbally and in writing of activities and problems within assigned area of responsibility; refers matters beyond limits of authority to manager.

Participates in special projects and performs other duties as requested.

Upholds the Crawford Code of Conduct.

Conducts training as needed to support the training team during migrations and/or cross skill mentoring to provide the skills and necessary coaching in support of the operations department.

Lines of Business Supported as QA/Trainer:

Medical Claims

Medical Billing

Medical Records Summary

Prior Authorizations

Utilizations Management

Medical Transcription

Sets up system record per claimant, ensuring that all claimant information is accurate such as date of birth, date of loss and other details necessary for processing their claims are encoded correctly.

Responsible for ensuring that all supervisor and client instructions in accordance to the Broadspire database are followed.

Creates appropriate employer letter depending on the Broadspire client instructions.

Creates medical provider letters whenever necessary based on claimant data.

Creates claimant letters based on client instructions, and the specific jurisdiction of the injured worker.

Sends letters of notice to the injured worker and other parties involved to the correct address.

Reviews new business life applications, ensuring type of plan, riders and basic client information are correctly reflected on the affinity markets system.

Documents declare medical and non-medical evidence on the underwriting sheet and ensure correct age and amount requirements and other necessary information are ordered.

Ensures that all medical and non-medical evidence are properly documented, and verifies unclear or vague Information with the client.

Processes all underwriting requirements within turnaround time.

Reviews the application, age and amount requirements and other supporting evidence as one, correlating all information at hand, verifies information as needed, and makes a final decision as to standard, declined, postponed or substandard based on the company’s underwriting manual and plan guidelines.

Reports MIB codes appropriately.

Communicates with banking consultants by e-mail regarding underwriting requirements and final decisions.

Relays and discusses any underwriting concerns to the manager.

Creates system accounts per annuitant, ensuring all information is correct on the Structured Manager application.

Reads and documents Attending Physician Statements, noting all medical co-morbidities that can affect client life expectancy and activities daily living.

Analyzes client co-morbidities, estimating how his disability and condition can affect his life expectancy, and applies appropriate rating based on the Fixed Structured Settlement guideline.

Sends out rated ages directly to brokers for structured settlement annuity agreement.