Charity Kouri
Church Hill,TN
Summary
Strong leader and problem-solver dedicated to streamlining operations to decrease costs and promote organizational efficiency. Uses independent decision-making skills and sound judgment to positively impact company success. Dependable Utilization Review Nurse promoting over 10 years of expertise in healthcare industry. Knowledgeable in admissions and stay reviews.
Overview
9
9
years of professional experience
Work History
Manager of Intake and Utilization Services
West Springs Hospital
01.2021 - 05.2023
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Implemented state regulatory guidelines and developed enhanced auditing process improvement initiatives within department resulting in 98% departmental compliance rating.
- Upgrading consent packets for new patients that were within state and regulatory guidelines.
- Development of new Standards of Operating Procedures, building cohesive workflows through interdepartmental strategy, and designed a full auditing framework for multi-point statical analysis of progress both in program development and financial claims data
- Performed prior authorization review of services requiring notification.
- Performed admission reviews based for medical necessity.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Supervised and maintained all utilization review documentation through Avatar.
- Facilitated workgroup meetings with Hospital Administrators and department heads to find effective solutions to issues.
- Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
- Established team priorities, maintained schedules and monitored performance.
- Directed training and retraining of employees to boost performance and enhance business results.
- Effectively supervised staff of 18 personnel by implementing company policies, protocols, work rules and disciplinary action.
- Cultivated positive rapport with fellow employees to boost company morale and promote employee retention.
- Supervised site investigations, reported issues and escalated those that required further assistance.
- Improved staffing during busy periods by creating employee schedules and monitoring call-outs.
- Optimized processes and supervised employees.
- Reduced workflow inconsistencies by recruiting and hiring capable staff members.
- Developed detailed plans based on broad guidance and direction.
- Used Behavioral Healthcare expertise, customer service skills and analytical nature to resolve customer concerns and promote loyalty.
- Coordinated all companies, business executives and site leadership teams by interacting effectively and establishing communication best practices.
- Launched quality assurance practices for each phase of development
- Implemented state regulatory guidelines and developed enhanced auditing process improvement initiatives within department resulting in 98% departmental compliance rating.
Clinical Care Coordinator
RMHP
10.2018 - 01.2021
- Oversaw quality assurance programs to enhance performance and consistently achieve superior care standards.
- Coordinated, monitored, assigned and documented patient and clinical care activities.
- Implement new policies and educate staff on changes.
- Developed, implemented, revised and evaluated policies and procedures.
- Complete authorizations for Medicaid, Medicare, and Commercial accounts.
- Establish medical necessity for IPMH, IOP, PHP, LTR, STR, OP therapy, psych testing, substance use, and ECT.
- Provide ongoing case management to patients to implement appropriate treatment plan, adhere to quality models and maximize utilization of services needed to achieve optimal outcomes.
- Managed emergency patients and handled patient treatment concerns.
- Fostered excellence by example by "setting pace" and being hands on mentor to clinical staff.
- Implemented successful healthcare program through professionalism, quality of care, medical teaching and patient satisfaction.
CNS Care Manager
Beacon Health Partners
10.2016 - 10.2018
- Consulted with supervisors to assess cases and plan strategies for enhancing care.
- Worked with providers to define quality metrics and outcome reporting process.
- Engaged in crisis call management connecting patients with the appropriate levels of care including emergency services, outpatient referrals, and inpatient hospitalization.
- Obtained authorizations on behalf of members with mental health and substance abuse problems.
- Coordinated referrals to specialists, hospitalizations, ER visits, ancillary testing and other enabling services for patients.
- Arranged transportation and documented details of discharge transition plans.
Director of Outpatient Services
Glen Oaks Hospital
03.2014 - 10.2016
- Initially the lead adult therapist/case manager. Direct clinical duties including group, individual, and family treatment modalities.
- Performing thorough and accurate psychosocial evaluations, developing and implementing master treatment plans, and providing for appropriate discharge planning/aftercare referrals.
- Recruited, hired, and trained all staff, providing direct supervision, ongoing staff development, and continuing education to employees.
- Developed and updated policies and procedures, maintaining compliance with statutory, regulatory and local, state and federal guidelines relating to HIPAA, benefits administration and general liability.
- Communicated with patients, ensuring that medical information was kept private.
- Direct day-to-day administrative and operational functions for 36-bed facility, providing guidance and leadership to departmental employees.
- Fostered excellence by example by "setting pace" and being hands on mentor to clinical staff.
- Created customized care plans, working with hospital staff and families to assess and meet individual needs.
Education
Master of Science - Psychology
Southwestern University
Waxahachie, TX04.2012
Skills
- Onsite Visits
- State & Regulatory Inspections/Audits
- Physician Consultations
- Health Equity
- Medicare, Medicaid, and Commercial Insurance
- Health Disparities
- Accreditation Services
- Determine Medical Necessity
- Procedures Compliance
- Treatment Options
- Utilization Management
- Operational Procedures
- Patient Admission
- Patient Transfers and Transitions
- Obtaining Authorizations
- Needs Assessment
- Project Implementation
- Patient Data Management Systems
- Interpersonal and Written Communication
- Software Applications
- Microsoft Office
- Patient Health Information Access
- Creative Thinking
- Acute Care
- Quality Improvement Plans
- HIPAA Regulations
- Managing Operations and Efficiency
- Therapy and Counseling
- Inpatient Services
- Insurance Eligibility
- EMR Systems
- Substance Abuse Treatment
- Performance Metric
- Federal Statutes
- Technical Proficiency
- Communications
- Documentation
- Leadership
Program Proficiencies
- Avatar
- Ability
- Availity
- 365 Microsoft applications
- Visio
- Power BI
- Forms
- Sway
- Camtasia
- Teams
- Zoom
- One Note
- One Drive
- Microsoft Office
- SharePoint
- Stream
- FlexCare
- Care Connect
- Avaya
- QHN
- Outlook
- Webex
- Essette
- Various insurance eligibility portals.
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
Do not go where the path may lead, go where there is no path and leave a trail.
Ralph Waldo Emerson
Timeline
Manager of Intake and Utilization Services
West Springs Hospital
01.2021 - 05.2023
Clinical Care Coordinator
RMHP
10.2018 - 01.2021
CNS Care Manager
Beacon Health Partners
10.2016 - 10.2018
Director of Outpatient Services
Glen Oaks Hospital
03.2014 - 10.2016
Master of Science - Psychology
Southwestern University
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