Colleen Giltner
Ocala
Summary
Dynamic healthcare professional with extensive experience in diverse care settings, specializing in Utilization Management. Recognized for exceptional written and verbal communication skills that foster strong collaborative relationships with colleagues and stakeholders. A proactive leader with an optimistic outlook, dedicated to achieving goals and enhancing operational outcomes while maintaining a thorough understanding of industry regulatory requirements. Committed to driving quality care and improving patient experiences through effective teamwork and strategic initiatives.
Overview
15
15
years of professional experience
Work History
Clinical Review Care Coordinator SNF authorizations
naviHealth/Optum
01.2025 - Current
- Review clinical documentation for determination of meeting Chapter 8 CMS criteria for SNF services for UHC MA/DSNP members.
- Coordinated patient care plans, ensuring alignment with clinical guidelines and patient needs.
- Facilitated communication between healthcare providers and patients to improve care transitions.
- Developed strong relationships with community partners, facilitating referrals and collaboration on behalf of patients.
- Improved communication among healthcare providers, streamlining the coordination of services for patients.
- Coordinated discharge planning, ensuring a smooth transition from SNF to home or other facilities.
- Ensured compliance with healthcare regulations and standards, maintaining patient safety and confidentiality.
- Collaborated with social services to connect patients with resources for housing, nutrition, and financial assistance, improving their overall wellbeing.
Home Health Care Coordinator
NaviHealth/Optum
03.2022 - 01.2024
- Review clinical documentation for determination of meeting Chapter 7 CMS criteria for HH services for UHC MA/DSNP members.
- Preceptor and leader for others on HH team for problem solving authorization and compliance issues.
- Assisted patients in navigating healthcare systems and accessing necessary resources effectively.
- Used company software and databases to maintain records of services performed and patient conditions.
- Maintained accurate and up-to-date documentation of patient records in accordance with HIPAA regulations.
- Advocated for patients'' rights within the healthcare system, working diligently to address concerns or barriers to care.
- Streamlined information sharing between healthcare providers by implementing secure electronic communication systems.
Senior staff Occupational Therapist
ORS/Encompass/Nurse on Call Home Health and Palm Gardens SNF PRN
01.2011 - 01.2022
Education
BHS with honors -
University of Florida
Gainesville, FLSkills
- Organized
- Proficient in CMS
- Confident decision-maker and communicator
- Microsoft Excel proficiency
- Analytical problem-solving
- Case management
- Multitasking and organization
- Team collaboration
- HIPAA compliance
- Utilization management
- Performance metrics
- Empathy and compassion
Communication
Communicate and collaborate with providers, physicians, members/families and colleagues via phone/email. Ensure quality and safe outcome for members to find best setting of care and safe discharge.
Leadership
Successively managed multiple assistants in outpatient and home health settings. Preceptor and leader on HH team with naviHealth/Optum.
Timeline
Clinical Review Care Coordinator SNF authorizations
naviHealth/Optum
01.2025 - Current
Home Health Care Coordinator
NaviHealth/Optum
03.2022 - 01.2024
Senior staff Occupational Therapist
ORS/Encompass/Nurse on Call Home Health and Palm Gardens SNF PRN
01.2011 - 01.2022
BHS with honors -
University of Florida
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