Dhorie Sim- LVN
Kaba Fusion
Downey,CA
1
Certification
27
years of professional experience
Experienced Case Manager, compassionate, care driven, believes in facilitating wellness for patients and their families. Skilled in coordination of care, organized, efficient and highly skilled in office administration, multi-tasking. Customer service oriented in a fast pace environment. Demonstrated versatility in adapting to ever increasing complexity of the healthcare industry particularly in commercial and managed care.
Work History
Nursing Coordinator
9 Years- Coordinated and assigned over 120 patients to RN/LVN based on patient referrals. Ensured RN/LVN received assignments aligned with their skill sets.
- Directs implementation of improved work methods and procedures to ensure patients are scheduled in accordance with policy in a timely and efficient manner.
- Established and maintained positive working relationships with employees and potential referral sources to enhance collaboration and support patient care.
- Directs implementation of improved work methods and procedures to ensure patients are scheduled in accordance with policy in a timely and efficient manner.
- Demonstrated ability to advocate for and strive to protect health, safety, and rights of patients.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches
LVN-Utilization Management Prior Auth
10 Months- Review, manage, and process 65 medical authorization requests and clinical referrals for inpatient or outpatient services for daily concurrent review, prior auth request.
- Established that all prior authorizations meet the strict regulatory guidelines dictated by government programs (such as Medi-Cal, Medicare). Ensures that all submissions strictly adhere to state and federal healthcare guidelines
- Integrates authorization matrix, ancillary rosters, DOFR, evidence based criteria- Milliman InterQual, CMS, Health Plan specific criteria. Accurately log authorization data, track queues, and clear pending items to prevent delays in patient care
Medical Case Manager
7 Months- Coordinates and facilitates comprehensive healthcare services for patients with complex, chronic, or acute medical need
- Coordinates individualized care plans across providers, ensuring timely follow-up and service continuity.
- Partnered with physicians, social workers, activity therapists, nutritionists, and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems.
- Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations, and procedural costs.
- Managed over 60 caseload to satisfy multiple patients with diverse needs.
- Coordinated individualized discharge plans to manage safe transition back into community and home environments.
LVN Case Manager
6 Years 11 Months- Acts as the primary, direct voice for over 100 patients within the nursing department, coordinating home infusion therapy visits, managing patient medical charts, and bridging communication between patients
- Facilitated problem-solving among team members to address complex issues related to patient care coordination effectively.
- Manage cross-functional scheduling across nursing, pharmacy, and intake departments
- Performed compliance with organization or department goals and regulatory agencies. Maintain confidentiality in compliance with Federal HIPPA regulations.
- Participated in continuous professional development opportunities to stay current with industry best practices in patient care coordination.
Senior Clinical Intake Specialist
8 Months- Conducted thorough evaluations of potential clients, accurately determining eligibility for services and appropriate care plans for over 50 patients.
- Led team meetings focused on continuous improvement initiatives, fostering a collaborative environment that encouraged innovative solutions to challenges faced by the department.
- Enhanced client intake process by streamlining data collection and implementing efficient workflows.
- Developed strong partnerships with external organizations to expand referral networks and enhance service offerings for clients in need.
- Established best practices for the intake team, fostering a culture of excellence within the department.
Lead Patient Care Coordinator
2 Years 11 Months- Assist with development, management and implementation of comprehensive Care Plan for over 100 patients monthly by active participation at interdisciplinary care team member.
- Tracks patient compliance, identifies barrier to care, educates, and assists with access to needed services. Refer patient to appropriate community resources, and social services.
- Ensures patients receive all needed services in a timely manner by appropriately delegating tasks to coordinator (Durable Medical equipment, transportation, MD appointments, and referrals to Specialist, etc).
- Coordinate ambulatory care needs requiring increased resources and support secondary to the complexity of their condition and/or social circumstances.
- Supervised daily patient flow, resolving access issues and escalating complex concerns promptly.
Pharmacy Buyer
12 Years 2 Months- Reconciled open purchasing orders monthly, assessed sales representatives' effectiveness, and maintained productive relationships with over 50 vendors while negotiating discounts and rebates with drug manufacturers.
- Maintained computerized patient profile to perform prospective reviews of drug therapy for each prescription dispensed, screening for drug therapy issues, incorrect dosage, drug allergy interactions, and drug disease contraindications.
- Supervised pharmacy technicians directly and worked independently within the scope of practice.
Education
Licensed Vocational Nurse - Nursing
Skills
Healthcare Administration
Experience in Managed Care
Chronic disease management
Quality assurance management
Procedure standardization
Clinical issues understanding
Infection control standards
Organization and planning
Problem resolution
Bilingual communication
Cultural sensitivity
Patient and family focused
Certification
- Licensed Vocational Nurse
Timeline
LVN-Utilization Management Prior Auth
Alta Med/Altura MSO
09.2025 - 07.2026Read More
Medical Case Manager
CalOptima Health
12.2024 - 07.2025Read More
Nursing Coordinator
Kaba Fusion
10.2017 - CurrentRead More
LVN Case Manager
Kabafusion
10.2017 - 09.2024Read More
Senior Clinical Intake Specialist
Briova Specialty Pharmacy
01.2017 - 09.2017Read More
Lead Patient Care Coordinator
Regal Medical Group
01.2014 - 12.2016Read More
Pharmacy Buyer
St Joseph Health System
03.2000 - 05.2012Read More
American Career College
Licensed Vocational Nurse from Nursing
Read More