Danita Moore
Victorville,CA
Summary
Healthcare Professional with more than 20 years of experience working with Medicare, Medical, HMO, PPO's, health plans. Experience ensuring high standards of culturally competent care for a wide variety of patients with diverse needs. Excellent people skills and thrives on helping to solve problems. Excellent verbal and written communication and time management skills. Highly knowledgeable in Federal and State healthcare mandates and regulations.
Overview
23
23
years of professional experience
Work History
National Care Navigator
Crossover Healthcare
03.2021 - Current
- Educated member on gaps in care and assisted with scheduling provider appointments.
- Assisted members with social determinants of health and linked to appropriate community resources.
- Maintained confidential health information according to state and federal regulations.
- Identified gaps in care and assisted in closure of gaps.
- Helped address client complaints through timely corrective actions and appropriate referrals.
- Worked with patients to ascertain issues and make referrals to appropriate specialists.
- Recommended service improvements to minimize recurring patient issues and complaints.
- Trained new staff on processing referrals, problem solving patient complaints, making sure all clinical documentation is accurate for specialty services, phone etiquette.
- Delivered support to medical staff in completion of patient paperwork.
- Managed over 50 patient calls per day.
Utilization Management Coordinator
Choice Medical Group
05.2019 - 03.2021
- Performed prior authorization review of services requiring notification.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Liaised with other healthcare professionals to develop comprehensive patient care plans and provide highest quality of care.
- Communicated with patients, ensuring that medical information was kept private.
- Processed and reviewed 100 home health referrals per month
Intake Supervisor
St. Bernardine's Home Health & Hospice
02.2018 - 04.2019
- Assessed clients' needs and determined eligibility for intake services.
- Answered phone calls and provided new clients with required paperwork to initiate service.
- Maintained accurate, up-to-date client records for reliable reference and communications.
- Completed intake assessment forms and filed clients' charts.
- Offered compassionate and attentive guidance to patients during moments of crisis and trauma.
- Built relationships with community agencies for timely service referrals.
- Attended case reviews and provided feedback on client progress.
- Trained and supervised new intake staff to deliver high-quality client care.
- Coordinated multidisciplinary teams to facilitate and deliver necessary client services.
- Increased hospice patient retention by %15
Case Management Coordinator
Caremore Medical Group
01.2007 - 12.2017
- Collaborated with multidisciplinary teams to facilitate client care and reduce case management barriers.
- Structured standardized case management processes to comply with regulatory agency statutes and standards.
- Created care plans that addressed clinical and financial challenges, family requirements and facilitated patient quality of life.
- Served as case coordinator, assuming responsibility for complex, high-volume assignments and guiding endeavors to successful completion.
- Made appropriate referrals, monitored client services in appropriate time frames, sought supervisory guidance as required, documented services provided and completed departmental billing procedures.
- Daily clinical rounds with an average of 15 patients with multidisciplinary Team.
Utilization Review Specialist
Arrowhead Regional Medical Center
04.2000 - 10.2005
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Performed prior authorization review of services requiring notification.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Wrote concurrent review on inpatients to facilitate discharge planning
- Prepared patient charts for medical audits.
- Processed 60-70 TAR's per day for authorization of treatment
Education
High School Diploma -
Pacific High School
San Bernardino, CA06.1997
Skills
- Highly Knowledgeable ICD 9/ICD -10, HCPCS,
- CPT coding
- Medical Terminology
- Electronic Medical Records
- Microsoft Office Suites
- Salesforce
- Elation
- Kinnser
- Provider Express
- Inovalon- My Ability
- EZCap
Timeline
National Care Navigator
Crossover Healthcare
03.2021 - Current
Utilization Management Coordinator
Choice Medical Group
05.2019 - 03.2021
Intake Supervisor
St. Bernardine's Home Health & Hospice
02.2018 - 04.2019
Case Management Coordinator
Caremore Medical Group
01.2007 - 12.2017
Utilization Review Specialist
Arrowhead Regional Medical Center
04.2000 - 10.2005
High School Diploma -
Pacific High School
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