Daracy Kuch
Perris,CA
Summary
Highly skilled and detail-oriented Licensed Vocational Nurse with 11 years of experience in utilization management. Proven ability to analyze complex medical records, identify discrepancies, and effectively advocate for appropriate decisions. Knowledge of industry regulations and best practices with effective leadership and communication abilities.
Overview
12
12
years of professional experience
Work History
Denials Review Nurse
Regal Medical Group
12.2020 - 01.2025
- Reviewing and processing of medical necessity decisions, including out-of-network, tertiary and modification cases to ensure accurate and appropriate denial decisions based on clinical criteria and guidelines
- Crossed trained to prior authorization review upon receipt of pre-service requests from members, and health care providers
- Provided assistance in training for onboarding nurses in denial review processes and letter issuance. Cross trained denial nurses to prior authorization review
- Audits of issued denial letters, identifying trends and areas for improvement in the denial letter and decision-making process
- Supervised a team of nurses and coordinators processing denial letters
- Monitored team performance to ensure timely, high-quality, and compliant letter generation
- Implemented best practices to improve workflow and maintain compliance with medical necessity criteria and regulations
- Collaborated with medical directors, prior authorization department, and compliance teams to resolve complex denial issues and optimize review processes
Medical Management Assistant
Scan Health Plan
03.2020 - 12.2020
- Entering Face sheets for Inpatient Admissions to Acute Care or Skilled Nursing Facilities
- Requesting for Information for clinical review as requested by the clinical team
- Reviewing Correspondence report for Transition Letters
Medical Assistant
Angkor Medical Center
10.2019 - 03.2020
- Front Office Duties: Answering multiple telephone lines, Scheduling patient appointments, Verifying patient’s eligibility, Prior authorization processing.
- Back Office Duties: Repeat of vital signs, Phlebotomy and Injections, IV preparation, Assisting the doctor with minor procedures
Appeals and Grievance Coordinator
Connected Care Health Services
01.2019 - 09.2019
- Processing of Member’s and Provider’s Appeals and Grievances for Part C services and Member’s grievances for Part D services
- Processing of decision notifications to members and submission to Maximus Federal Services for higher level of review
Utilization Management Assistant
St. Joseph Heritage Healthcare
04.2016 - 01.2019
- Prior authorization processing for professional and outpatient service
- Processing Notification of Action letters (denials and modifications), termed provider letters, scheduling Peer to Peer reviews
Utilization Management Coordinator
Coast HealthCare, LLC.
10.2015 - 02.2016
- Prior authorization processing for professional and outpatient services (Commercial & Medicare Line of Business) (Urgent, Direct & Standard)
Utilization Management Coordinator / Denial Coordinator
Accountable Health Care IPA
07.2014 - 10.2015
- Prior authorization processing for professional and outpatient services based on DOFR review
- (Medi-Cal, Commercial, Covered California, Medicare Line of Business) (Urgent, Direct & Standard)
- Processing of Notice of Action letters, such as Denials, Modifications and Delays
Utilization Management Denial Coordinator
HealthSmart, MSO, Inc
06.2013 - 07.2014
- Drafting and faxing denial letters for all IPA’s and all lines of business
- Fax distribution
- Rescind letters for termed members, running reports for termed providers, direct access authorization processing, assisting with appeals and grievances and monthly denial reporting to health plans
- Assisting denial and health plan oversight specialists by drafting Outpatient and Inpatient denials, including NOMNC letters with member’s demographics
Education
Diploma - Vocational Nursing
Concorde Career College
Garden Grove, CA03.2020
Diploma - Medical Assistant
Clarita Career College
Long Beach, CA01.2008
Skills
- 40 wpm
- Microsoft Outlook, Excel, Word
- Healthcare systems
- Medical necessity review: CMS, Medi-Cal, Milliman (MCG), and InterQual Guidelines
- Prior authorization processing
- Denial management
- Regulatory compliance
- Clinical documentation
- Auditing processes
- Team leadership
- Effective communication
- Conflict resolution
- Clinical judgment
Personal Information
Title: Licensed Vocational Nurse, LVN.
Timeline
Denials Review Nurse
Regal Medical Group
12.2020 - 01.2025
Medical Management Assistant
Scan Health Plan
03.2020 - 12.2020
Medical Assistant
Angkor Medical Center
10.2019 - 03.2020
Appeals and Grievance Coordinator
Connected Care Health Services
01.2019 - 09.2019
Utilization Management Assistant
St. Joseph Heritage Healthcare
04.2016 - 01.2019
Utilization Management Coordinator
Coast HealthCare, LLC.
10.2015 - 02.2016
Utilization Management Coordinator / Denial Coordinator
Accountable Health Care IPA
07.2014 - 10.2015
Utilization Management Denial Coordinator
HealthSmart, MSO, Inc
06.2013 - 07.2014
Diploma - Vocational Nursing
Concorde Career College
Diploma - Medical Assistant
Clarita Career College
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