Chelsea Edwards
Lee's Summit,MO
Summary
Compassionate Occupational Therapist with background in patient advocacy and care management. Experience includes working with diverse patient populations, coordinating healthcare services, and ensuring efficient delivery of high-quality care. Strengths entail strong interpersonal skills for liaising between patients, healthcare providers, and insurance companies; and problem-solving abilities for addressing any issues or barriers to care. Previous roles involved improved patient satisfaction rates and streamlined care processes along with utilization management.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Therapy Services Specialist
Elevance
04.2025 - Current
- Conducted telephonic and virtual assessments to identify participant needs and recommend supportive services.
- Recommended durable medical equipment (DME) tailored to patient diagnoses, enhancing home safety.
- Educated members on comprehensive assessment benefits to reduce abrasion.
- Documented justifications for proposed adjustments in caregiver hours.
- Collaborated with management and team leads to optimize workflow feedback and learning processes.
- Worked with case managers to revise member care plans, ensuring community safety.
Home Health Care Coordinator - Team Lead
Optum
02.2022 - 04.2025
- Developed and optimized home health workflows to enhance efficiency and meet turnaround times.
- Led the interview process to hire candidates aligned with Optum values and business goals.
- Created and delivered presentations on business practices to educate new and existing team members.
- Developed and edited the home health SharePoint website to enhance user accessibility and information dissemination.
- Developed and updated home health workflows to enhance operational efficiency.
- Mentored new colleagues to enhance their independence and improve quality reviews during audits.
- Contributed to and presented in three successful launches, guiding new teams and states to success.
- Collaborated with provider relations team and home health agencies to achieve successful patient outcomes.
- Completed leadership courses to enhance management skills and effectively handle diverse team dynamics.
- Oversaw utilization management for home health services, targeting decreased overutilization for United Healthcare Medicare Advantage patients.
- Tracked team performance metrics to ensure KPIs were met with Tableau.
Appeals and Denials Coordinator
Navihealth
08.2020 - 02.2022
- Created high-quality DENCs and health plan appeal packets, ensuring adherence to individual health plan guidelines.
- Collaborated with team members to enhance productivity scores, and mentored colleagues by providing guidance and resolving queries.
- Assisted the team with pending health plan determinations to meet the goal of reducing backlogs, and actively contributed to special projects.
- Created templates for denial letters to ensure accuracy, and ensure compliance with Medicare and health plans.
Skilled Inpatient Care Coordinator
Navihealth
01.2019 - 08.2020
- Managed a caseload of 30 Humana members using the nHpredict outcome report to determine appropriate length of stay based on comorbidities and diagnosis.
- Collaborated with team members to maintain 90%+ productivity during monthly reports and ensure detailed, accurate charting for successful member care transitions.
- Conducted face-to-face visits with members to facilitate seamless transitions from post-acute care to home, adhering to specific health plan guidelines.
- Evaluated clinical records to determine patient eligibility under CMS chapter 8 guidelines.
Home Health Occupational Therapist
Kindred at Home
Lexington, KY
01.2018 - 12.2018
- Consulted with patients to assess conditions, obtain histories and discuss objectives.
- Personalized treatment plans to complement specific abilities and recovery goals of each patient.
- Adjusted treatment plans based on in-progress evaluations and patient satisfaction.
- Requisitioned splints, braces and computer-aided adaptive equipment for client use.
- Utilized assistive technology devices such as wheelchairs or communication aides to facilitate improved function in the home setting.
- Educated patients and families to help understand disease process, injury and limitations.
- Instructed family members on how to use adaptive equipment for safe performance of ADLs.
Occupational Therapist
Signature HealthCARE
Winchester , KY
10.2013 - 12.2017
- Created reports documenting patient assessments, treatments provided, progress made towards goals and recommendations for future care.
- Monitored patient progress through periodic re-evaluations to ensure desired outcomes were achieved or modified as needed.
- Collaborated with interdisciplinary teams to ensure a holistic approach to patient care.
- Designed therapeutic activities to improve physical strength, coordination, balance, posture, sensory integration skills.
- Adjusted treatment plans based on in-progress evaluations and patient satisfaction.
- Advocated for patients to receive necessary services and supports within their community.
- Led training sessions for caregivers and healthcare staff on safe and effective patient handling techniques.
- Supervised Certified Occupational Therapy Assistants (COTAs) in a skilled nursing facility setting.
Education
Master of Science - Occupational Therapy
Eastern Kentucky University
Richmond, KY08-2013
Bachelor of Science - Occupational Science
Eastern Kentucky University
Richmond, KY05-2011
Skills
- Multidisciplinary team collaboration
- Process improvements
- Clear communication
- Documentation
- Goal setting
- Patient education
- Patient advocacy
- Multitasking and organization
- Quality Assurance
- Compliance
Certification
OTR/L; Dementia Care Certification; BLS; Lean Six Sigma Green Belt (currently in process of earning)
Timeline
Therapy Services Specialist
Elevance
04.2025 - Current
Home Health Care Coordinator - Team Lead
Optum
02.2022 - 04.2025
Appeals and Denials Coordinator
Navihealth
08.2020 - 02.2022
Skilled Inpatient Care Coordinator
Navihealth
01.2019 - 08.2020
Home Health Occupational Therapist
Kindred at Home
01.2018 - 12.2018
Occupational Therapist
Signature HealthCARE
10.2013 - 12.2017
Master of Science - Occupational Therapy
Eastern Kentucky University
Bachelor of Science - Occupational Science
Eastern Kentucky University