Dana Lopez

• Assisted clients in developing and achieving short-term and long-term goals.
• Provided advocacy for clients to ensure their needs are met through appropriate services.
• Conducted assessments of client's physical, psychological, cognitive, social, economic and environmental needs.
• Developed service plans based on assessment findings; monitored effectiveness of plans regularly.
• Facilitated the coordination of medical appointments and transportation for clients when needed.
• Maintained accurate records of client visits and progress notes in accordance with agency policies and procedures.
• Educated family members about patient's condition, treatments and available resources.
• Participated in team meetings with other staff members to discuss case management issues.
• Monitored client's compliance with medications prescribed by physician or psychiatrist, if applicable.
• Arranged referrals for additional services such as housing assistance or financial aid programs when needed.
• Offered emotional support to help patients cope with stressors associated with their illness or disability.
• Ensured that all documentation is completed accurately according to state regulations.
• Created plan of care to assist patients in reducing problems or barriers to achieve optimal level of health.
• Facilitated communication between members of health care delivery while involving clients in decision-making processes to minimize service fragmentation.
• Attended and actively participated in meetings to provide and receive information on patient progression.
• Monitored risk assessment by using available tools and implementing discharge interventions.
• Liaised with multidisciplinary team to discuss barriers to discharge or concerns impacting readmission risk.
• Used motivational interviewing to educate, support and motivate change.
• Established solid relations with leadership and staff by attending board meetings and coordinating interdepartmental information exchanges.

Experience in writing denial letters for compliance.

Experience in conducting front end reviews, Pre-Authorizations, and Utilization review for Medicare and Commercial Lines of business.

• Performed medical necessity reviews of inpatient and outpatient services to ensure compliance with relevant regulations and standards.
• Conducted utilization management activities such as pre-certification and pre-authorization requests for services rendered by health care providers.
• Consulted with physicians regarding appropriate documentation requirements when necessary to support clinical decision making.