Elizabeth Hyde

Dedicated Speech-Language Pathologist with extensive experience in diverse clinical environments, specializing in adult and geriatric care. Proven expertise as an interdisciplinary clinical reviewer for utilization management, with a strong understanding of Medicare regulations and case management. Demonstrates exceptional organizational and problem-solving skills, consistently enhancing patient outcomes.

• Active AL State SLP Licensure
• Certificate of Clinical Competence in SLP (ASHA)
• Vital-Stim Certified
• SPEAK OUT! Provider
• UHC O&E M&R Certified Level 1 & 2

Utilization Management

· Performs inter-disciplinary medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria

· Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care.

· Collects, documents, and maintains all members’ clinical information in health management systems to ensure compliance with regulatory guidelines.

· Consistently exceeds productivity standards and completes authorization reviews in timely manner while maintaining high level of documentation accuracy.

· Consistently met and exceeded Productivity score as evidence by 2024 annual personal average of 127%; Consistently met and exceeded Individual Task TAT < 3 hours criteria as evidenced by annual personal average of 1.1 hrs. Consistently met or exceed the targeted annual QAR score with personal achievement of 95.6%.

· Collaborates with providers and provides education on utilization processes to promote high quality and cost-effective medical care to members.

· Utilized InterQual criteria to support services and level of care clinically indicated.

Patient Care

· Consulted, evaluated and diagnosed communication and cognitive-communication deficits and dysphagia across diverse clinical settings.

· Developed individualized plans for patients to address impairments in communication, swallowing, and cognitive-communication skills.

· Provided direct therapy sessions using evidence-based practices to improve the communication of patients.

· Collaborated with inter-disciplinary teams to ensure joint approach to patient care.