Daria Kossuth

• Led cross-functional teams to achieve project goals, fostering collaboration and innovation.
• Increased team productivity by implementing streamlined processes and effective communication strategies.
• Increased client satisfaction by building strong relationships and addressing their needs promptly.
• Successfully resolved escalated issues, preventing potential loss of valuable clients while maintaining positive relationships with all parties involved.
• Achieved departmental goals by developing and executing strategic plans and performance metrics.
• Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
• Led change management initiatives to drive organizational transformation without compromising employee morale or productivity levels.
• Ensured compliance with industry regulations and legal requirements by implementing comprehensive policies and training programs for staff members.
• Accomplished multiple tasks within established timeframes.
• Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
• Streamlined workflows by identifying bottlenecks in existing systems and implementing appropriate solutions.

Workers’ Comp and Auto No- Fault Department

• Lead a team of utilization management nurses and support staff in a busy auto injury and workers’ comp department, overseeing all aspects of utilization management processes
• Lead the Review Services team comprised of Utilization Review Coordinators, Independent Medical Exam Coordinators and Appeal Reviewers in the auto injury and workers’ comp department, overseeing all aspects of review services processes
• Conducted regular performance evaluations, provided feedback, and implemented strategies to improve team productivity and efficiency
• Developed and implemented utilization management protocols, ensuring adherence to industry guidelines and best practices
• Collaborated with medical directors, providers, and insurance companies to facilitate effective utilization review and claims management
• Assist IT with updates to review software to streamline processes, resulting in a reduction in claim turnaround time and increased accuracy
• Conducted regular training sessions for staff on utilization management policies, procedures, and compliance requirements
• Monitored and reported on key performance indicators (KPIs), tracking team productivity, turnaround times, and quality metrics
• Acted as a liaison between the utilization management team and other departments, fostering open communication and collaboration
• Provides daily leadership, direction, resources, training, evaluation, and support to department staff in coordinating care and resource utilization
• Monitor staff assignments and adjust based on staffing levels.
• Hired, managed, developed and trained staff, established and monitored goals, conducted performance reviews and administered salaries for staff
• Develop and implement Quality Improvement Policies for URAC compliance.

• Conducted thorough reviews of medical records, treatment plans, and diagnostic tests to ensure compliance with medical guidelines and appropriate resource utilization
• Collaborated with medical directors, providers, and insurance companies to facilitate the approval of medical services and procedures
• Assessed the medical necessity and appropriateness of requested services, making evidence-based determinations
• Developed and maintained relationships with network providers, addressing questions, concerns, and issues related to utilization management
• Documented utilization management activities accurately and comprehensively, ensuring compliance with regulatory requirements.
• Collected and inputted case data in managed care system and timely and accurately generated required correspondence and review notification for management.
• Screened medical records and information for necessity and appropriateness and referred for physician review cases not meeting medical criteria.

• Assisted in the delivery of nursing care to patients in a medical-surgical unit
• Monitored patients' condition, recorded vital signs, and reported any changes to the registered nurse
• Administered medications and treatments under the supervision of the nursing team
• Assisted with activities of daily living, including bathing, dressing, and feeding
• Collaborated with the healthcare team to develop and implement care plans
• Assisted inpatient admissions, transfers, and discharges
• Documented patient care activities accurately and timely.

• Prepare patients for consult visits with Radiation Oncologists
• Educate patients on procedures leading up to radiation treatment
• Assist physician during office procedures
• Along with the physician, meet with patients for a weekly check on their progress with radiation treatments
• Support the receptionist in fielding phone calls and insurance verification when needed
• Maintain spreadsheets that track patient treatment decisions.