Dunshell Black
Glenn Heights
Summary
Utilization Management professional with 15+ years of healthcare operations experience. Expertise in prior authorizations, care coordination, and regulatory compliance (CMS, Medicare, URAC, NCQA). Proven ability to manage high-volume workflows, coordinate physician reviews, and support complex member needs.
Overview
17
17
years of professional experience
Work History
Clinical Intake Specialist
Humana
Irving
01.2019 - Current
- Process high-volume prior authorizations with accurate CPT/ICD-10 coding
- Triage cases based on urgency and compliance timelines
- Coordinate with physicians and care teams for timely decisions
- Support Nurse Advice Line and transplant coordination workflows
- Maintain compliance documentation that aligns with HIPAA, URAC and NCQA
- Communicates effectively with patients regarding intake processes and requirements.
Scheduler / Distributor
Humana
Irving
01.2017 - 01.2019
- Scheduled physician peer reviews and managed case distribution
- Maintained workflow queues to meet turnaround standards
- Collaborated with clinical teams to improve efficiency
Clinical Specialist
Humana
Irving
01.2014 - 01.2017
- Coordinated physician reviews and denial workflows
- Prepared documentation for audits (CMS, URAC, NCQA)
- Ensured compliance and accurate record-keeping
Clinical Staff Assistant II
UT Southwestern Medical Center
Dallas
01.2009 - 01.2014
- Managed patient scheduling and records (EMR, HIPAA compliant)
- Processed referrals, pre-certifications, and billing support
- Coordinated with providers to support patient care
Education
High School Diploma -
A. Maceo Smith High School
Skills
- Utilization Management & Prior Authorization
- Case Triage
- Physician Peer Review Coordination
- Denials & Appeals Support
- Nurse Advice & Transplant Coordination
- Regulatory Compliance (CMS, URAC, NCQA)
- Workflow Optimization & Queue Management
- Epic EMR
- OAS Gold
- Clarity Reporting
- Microsoft Office Suite
Leadership Experience
- Resource for team on authorization workflows
- Support staff with complex intake and distribution issues
Timeline
Clinical Intake Specialist
Humana
01.2019 - Current
Scheduler / Distributor
Humana
01.2017 - 01.2019
Clinical Specialist
Humana
01.2014 - 01.2017
Clinical Staff Assistant II
UT Southwestern Medical Center
01.2009 - 01.2014
High School Diploma -
A. Maceo Smith High School