Diana Garcia
Riverview
Summary
Experienced Care Management and Patient Care Coordinator with 10+ years of healthcare experience supporting complex populations in managed care and infusion services. Strong expertise in benefits verification, prior authorizations, and navigating Medicare, Medicaid, and commercial insurance guidelines. Skilled in risk stratification, utilization support, care transitions, and reducing avoidable hospitalizations. Proficient in EPIC, Salesforce, CPR+, and Microsoft Office Suite. Bilingual in English and Spanish with extensive telephonic and remote care coordination experience.
Overview
11
11
years of professional experience
Work History
Infusion Nutrition Patient Care Coordinator
Coram Infusion Services
FL
12.2024 - Current
- Verify insurance eligibility and benefits in accordance with Medicare, Medicaid, and commercial payer guidelines.
- Secure and manage prior authorizations, ensuring services meet medical necessity and coverage criteria.
- Review payer documentation requirements and resolve authorization denials to prevent treatment delays.
- Coordinate multidisciplinary care for patients requiring enteral and infusion therapy.
- Support utilization processes by confirming appropriate level of care and timely service initiation.
- Conduct proactive outreach to address coverage, financial, and adherence barriers.
- Maintain accurate EPIC documentation to support compliance, audits, and reimbursement standards.
Patient Care Coordinator
Coram Infusion Services
FL
04.2023 - 12.2024
- Coordinated complex referrals and infusion services while ensuring compliance with payer policies.
- Verified insurance coverage, obtained authorizations, and communicated with payers regarding eligibility and benefits.
- Monitored coverage limitations to ensure timely access to medically necessary services.
- Documented patient and payer interactions within EHR systems.
Lead Patient Care Coordinator
Coram Infusion Services
FL
10.2020 - 07.2022
- Supervised and trained care coordination staff on documentation, compliance, and payer guidelines.
- Oversaw intake, admissions, and discharge processes to ensure seamless continuity of care.
- Acted as liaison between providers, members, and insurance representatives to resolve coverage and service gaps.
- Assisted with workflow improvements to reduce authorization delays and improve service turnaround times.
Care Management Coordinator
Independent Living Systems (ILS)
Miami
01.2015 - 10.2016
- Managed a caseload of Medicare and Medicaid managed care members, conducting comprehensive medical, behavioral, and psychosocial assessments to identify high-risk conditions and care gaps.
- Stratified members by risk level and developed individualized, goal-oriented care plans to improve outcomes and reduce avoidable utilization.
- Collaborated with interdisciplinary teams including physicians, behavioral health providers, and community agencies to coordinate cost-effective, medically appropriate care.
- Facilitated transitions of care following hospitalizations and ER visits to reduce preventable readmissions.
- Monitored member progress and adjusted care plans based on clinical status, benefit eligibility, and payer guidelines.
- Addressed social determinants of health by coordinating transportation, financial assistance, home health services, DME, and specialty referrals.
- Performed proactive outreach to improve appointment adherence, medication compliance, and preventative care participation.
- Maintained audit-ready documentation in compliance with CMS, managed care contracts, and HIPAA standards.
Education
Bachelor of Science - Psychology
Colorado Technical University
11.2028
Registered Behavior Technician (RBT) 40-Hour Training - Applied Behavior Analysis
New Horizons Therapy Inc
02-2026
Skills
- Care management
- Risk stratification
- Utilization review support
- Benefits verification
- Prior authorizations
- Medicare and Medicaid guidelines
- Commercial insurance policies
- Medical necessity criteria
- Transitional care planning
- Discharge planning
- Care gap resolution
- Social determinants of health
- Epic EHR proficiency
- Salesforce expertise
- CPR certification
- Microsoft Office proficiency
- HIPAA and CMS compliance
- Bilingual English/Spanish
Languages
English
Professional
Spanish
Professional
Timeline
Infusion Nutrition Patient Care Coordinator
Coram Infusion Services
12.2024 - Current
Patient Care Coordinator
Coram Infusion Services
04.2023 - 12.2024
Lead Patient Care Coordinator
Coram Infusion Services
10.2020 - 07.2022
Care Management Coordinator
Independent Living Systems (ILS)
01.2015 - 10.2016
Bachelor of Science - Psychology
Colorado Technical University
Registered Behavior Technician (RBT) 40-Hour Training - Applied Behavior Analysis
New Horizons Therapy Inc