Diane Maksymkow
Maryville,TN
Summary
Clinical Care Coordinator, Case Manager and Physical Therapist with supervisory and leadership experience applying operational improvements and problem-solving skills towards enhancing business plans and day-to-day activities. Highly experienced in clinical and client services, quality improvement and workflow processes. Results-driven, detailed oriented team player with solid understanding of health related services, programs, client management and URAC, CMS compliance. To seek a new position that will leverage my experience & talents, and bring value to the team.
Overview
17
17
years of professional experience
Work History
Clinical Care Coordinator
UnitedHealth Group, Optum
07.2022 - Current
- Senior Care Coordinator for UM team of 33 Physical and Occupational Therapists.
- Mentor new clinical case managers for proper onboarding, program training and development and orientation processes.
- Analyze, evaluate and perform timely reviews to establish care for patients based on applicable EMR data.
- Coordinate with UM manager on workflow processes and program changes, contract adherence and team training. Set up educational programs for clinical staff to enhance skills and knowledge.
- Liaised with Program Developers for UAT and providing feedback for system changes.
- Communicate with clients on UM decisions, case management, escalated and urgent submissions and applicable internal/external stakeholders as needed.
Supervisor of Clinical Operations
UnitedHealth Group, Optum-OrthoNet LLC
04.2018 - 07.2022
- Responsible for oversight and facilitation of day to day operations for utilization management team consisting of 27 case managers and 16 supportive staff
- FTE budget of $2.6M; maximizing workload output, minimizing overtime expenditures
- Highly successful working within tight deadlines and fast-paced environment; prioritize workloads and multi-task; maintain consciousness of deadlines to meet client's needs
- Worked directly under Manager of Clinical Services and Medical Directors office to ensure appropriate clinical guidelines are developed and executed with quality driven approach
- Participated in internal and external reporting and work groups to improve process and/or quality outcomes to meet contractual requirements and regulatory requirements
- Responsible for data collection, identification of trends/strategic planning, evaluate solutions and provide gap closure
- Worked collaboratively with network providers and vendor management to enhance client relationships
- Responsible for new hire training and ongoing education on clinical and process developments
Clinical Case Manager
OrthoNet LLC
07.2006 - 03.2018
- Performed pre-certification, concurrent and retrospective reviews for applicable product lines with emphasis on utilization management, discharge planning, clinical outcomes and quality of services for multiple health plans
- Consistently complied with applicable laws and URAC regulations, adhered to Medicare, Medicaid and Commercial regulations
- Performed 50+ clinical reviews per day with performance of additional assignments for meeting contract requirements
Education
Master of Arts - Physical Therapy
Touro College
Dix Hills NYBachelor of Arts - Economics
State University of New York (SUNY)
Albany, NYSkills
- Project Management/Presentational skills
- Time Management/ Multi-tasking
- Creative Thinking/Problem solving
- Interpersonal skills/Team builder
- Strategic planning/Results driven
- Computer software and application knowledge
Timeline
Clinical Care Coordinator
UnitedHealth Group, Optum
07.2022 - Current
Supervisor of Clinical Operations
UnitedHealth Group, Optum-OrthoNet LLC
04.2018 - 07.2022
Clinical Case Manager
OrthoNet LLC
07.2006 - 03.2018
Master of Arts - Physical Therapy
Touro College
Bachelor of Arts - Economics
State University of New York (SUNY)
Licensures
New York #014609-1
Tennessee #7657
Continuing Education Available upon request
Licensure's
State of Tennessee Board of Physical Therapy #7657
State of New York Office of Professions, Physical Therapy #014609-1
Interests
- Running
- Weight Training
- Church Volunteer for the Homeless community