ELIZABETH MCCOY
Tampa,FL
Summary
Experienced, professional, self-directed Manager I Utilization Management with outstanding ability to maintain high-quality work while meeting strict deadlines. Aiming to advance professionally in the Elevance organization. By integrating my clinical healthcare experience and managerial skills, I will be able to execute and interact with a diverse population effectively. I am ready to commit to a new challenge full of opportunities in the corporate field.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Manager I Utilization Manager
Simply Healthcare Plans Inc.
10.2021 - Current
- Developed clinical protocols that use evidence-based best practices to provide consistency and drive performance outcomes.
- Manage over 40 direct reports with over 300 case managers reporting/requesting authorizations.
- Oversee/ Manage a Simply LTC plan that averaged over 15,000 authorizations a month.
- Create and present financial reports to the Executive Leadership Team for budgeting and team performance.
- Created automated systems to increase efficiency.
- Assisted with the implementation of ACMP/AUMI.
- Assisted with hiring, coaching, counseling and evaluating performance of direct reports.
- Developed, evaluated protocols and guidelines for CM approved cases, Letters team, and nurses team.
- Partner with Medical Directors with cost-effective implementations.
- Partner with multiple teams such as Provider Relations, case Manager Team, Medicaid and Medicare teams to improve consistency and improve processes.
- Audit reports to cut-cost and improve budget.
Utilization Management Senior Physical Therapist
Simply Healthcare Plans Inc.
01.2017 - Current
- Medical Management Team Lead Utilization-Post Acute Team.
- Experienced in the Post-Acute Team with transitions to skilled nursing facilities, acute Inpatient rehabs, long-term acute care, custodial, and medical fragile cases.
- Medicaid and Medicare experienced.
- Subject matter Expert (SME) for the Post-Acute Utilization Management Team.
- Successfully monitored and mentored new hires.
- Balance assignment within my team daily for 6 nurses.
- Utilization management telephonically by, fax, and via EMR with daily rounds.
- Work closely with medical directors for discharge planning, transfers approvals, DME, Home health, transportation, and pharmacy request.
- Ensure medically appropriate, cost-effective care through assessing the medical necessity of the patient admission, transfers for out of network services, and appropriateness of treatments during the facility stay.
- Conducts reviews for initial and continued medical necessity.
- Collaborate with clinical managers, physicians, and other teams to ensure compliance with timelines and regulations.
- Ensured HIPAA compliance.
- Responsible for custodial monthly report.
- Collaborates with the case manager- discharge planner and Social Worker regarding the safe discharge of residents.
- Assist and establish a short-term and long-term placement for difficult discharge members with HIV, behavioral health issues, and homelessness.
- Monitors facility practice to ensure compliance with guidelines for participation in Medicare, Medicaid, and other benefit programs.
- Collaborates with AHCA for long-term care applications and levels of care.
- Collaborates with the Alliance for Aging in community long-term care applications.
- Proficient with McKesson InterQual and MCG criteria to determine medical necessity.
Lab Assistant- Neuromuscular Systems I, II, III
Nova Southeastern University
01.2014 - Current
- Facilitate excellent communication and expectation setting in challenging blended format, leveraging remote collaboration sessions, video education, in-person teaching, and lab instruction.
- Preparing the lab environment, monitoring student progress, and facilitating student participation in learning activities.
- Effective communication with the lead instructor regarding student performance or issues that arise to ensure the delivery of consistent content and testing.
- Assist with grading practicals and other required assignments.
- Assist students in learning and understanding the class material.
- Assist professors with case studies.
- Provide constant supervision to unlicensed staff as necessary.
Inpatient Physical Therapist
Bay shore Pointe Nursing Home and Rehab Center
01.2013 - 01.2017
- Senior Physical Therapist. Supervising and managing PTAs, PTs, PTA students, and volunteers in documentation, treatment, and education.
- Perform evaluations, assessments and conducts treatments/interventions programs and activities.
- Interpret Physician referrals and make appropriate recommendations based on individual impairments and limitations.
- Work with a wide range of pathologies from Neuromuscular to Orthopedic.
- Complete daily documentation in electronic and written formats.
- Perform Home Evaluations.
- Perform evaluations, assessments, and recommendations on DME, orthotics, and prostheses.
- Refer patients to other health care professionals if necessary.
Inpatient Physical Therapist
Palm Garden Rehab
01.2010 - 01.2013
- Senior Physical Therapist overseeing all PTs and PTA's in documentation, treatment, and education.
- Trained staff in CPM and ACP Technology
- Performed evaluations, assessments and conducts treatments/interventions programs and activities.
- Interpreted Physician referrals and make appropriate recommendations based on individual impairments and limitations.
- Worked with a wide range of pathologies from Neuromuscular to Orthopedic.
- Provided supervision and guidance/training to PTA's, students, and volunteers.
- Documentation in computer-based and traditional written forms.
- Performed Home Evaluations.
- Completed evaluations, assessments, and recommendations on DME, orthotics, and prostheses.
- Referrals to other professionals for further evaluations.
Acute Care
University of Florida Shands Hospital
01.2009 - 01.2010
- Provided supervision and guidance/training to PTA's, students, and volunteers.
- Performed Home Evaluations.
- Evaluations, assessments, and recommendations on DME, orthotics, and prostheses.
- Worked in multiple departments in a University Hospital setting, including Acute Inpatient Rehabilitation, Acute Neurology, General Medical/Surgery, Acute Orthopedics, Cardiothoracic Surgery, Wound Care.
- Rotating position throughout the hospital 820 beds in different areas such as neurological, pulmonary-cardiac transplants, and oncology.
- Identified proper placement for each individual based on prognosis and diagnosis.
- Built relationships and liaised between trauma service and rehabilitation staff.
- Enhanced education program for early mobilization within Surgical Intensive Care Unit.
- Treated individuals with various acute traumatic injuries, including CHI, SCI, orthopedic fractures, & wounds.
Pediatrics
Levy County School System
01.2009 - 01.2010
- Assisted school-teachers and school teams on proper positioning for children with CP, Angel man’s syndrome, Down syndrome, and other pathologies.
- Performed evaluations, assessments, and conducted treatments/interventions.
- Involved students in classroom activities by proper positioning.
- Educated aides, families, and teachers in proper body mechanics.
- Selected adequate school furniture, or assistive technology that benefited the student to participate in the classroom actively.
Outpatient Physical Therapist
Memorial Hospital West
01.2008 - 01.2009
- Rotating position in four different areas Inpatient/Outpatient/Pool Therapy/Lymphedema.
- Performed evaluations, assessments, and conducted treatments/interventions programs and activities.
- Interpreted Physician referrals and made appropriate recommendations based on individual impairments and limitations.
- Worked with a wide range of pathologies from Neuromuscular to Orthopedic.
- Provided Supervision and guidance/training to PTA’s.
- Documentation performed computer-based and regular written forms.
- Evaluation, recommendation, and referrals on orthotic devices.
Education
Master of Business Administration - undefined
Western Governors University
Salt Lake City, UT2019
Doctor of Physical Therapy - Physical Therapy
Nova Southeastern University
Davie, Florida2007
Bachelor’s - Health Science
Florida International University
Miami, FL2004
Skills
- Strive for excellence in education
- Adaptive to changing environments
- Experienced with staff education and training
- Excellent verbal and written communication
- Exceptionally knowledge of medical clinical practice
- Attentive to Detail
- Solid organizational and documentation skills
- Adept at multi-tasking
- Cultural awareness and sensitivity
- Experienced in different settings from acute hospitals to home health
- Highly experienced about Medicaid/Medicare policies with extensive knowledge in negotiations and network skills
Affiliations
- 2004-2007 Active Member, American Physical Therapy Association 20014-present Active Member, American Physical Therapy Association 2004-2007 Active Member, Florida Physical Therapy Association
- 2014-present Active Member, Florida Physical Therapy Association
Certification
- Lymphedema Certified - Academy of Lymphatic Studies-2007
- Certified Specialist in Geriatric - ABPTS Board Certified Specialist - 2014
- Cardiopulmonary resuscitation - American Heart Association-2021
- Credentialed Clinical Instructor Program - American physical Therapy Association-2014
Extracurricular
- The Velvet Suite - The She-Suite sponsor by Elevance Health ( 2023 - Current).
- Simply Healthcare Florida Ambassador (2020 -2022).
- Member of the American physical Therapy Association (2007 - Curent).
- Girl Scout Leader Troop 32223.
Skills
- Facets, Macess, SharePoint, AUMI/ACMP.
- Carecast and Optima.
- Windows, Microsoft office, Microsoft Project, and Adobe.
- Microsoft Teams, and Cisco Webex.
Language Proficiency
- Fluent in Spanish reading and writing.
Timeline
Manager I Utilization Manager
Simply Healthcare Plans Inc.
10.2021 - Current
Utilization Management Senior Physical Therapist
Simply Healthcare Plans Inc.
01.2017 - Current
Lab Assistant- Neuromuscular Systems I, II, III
Nova Southeastern University
01.2014 - Current
Inpatient Physical Therapist
Bay shore Pointe Nursing Home and Rehab Center
01.2013 - 01.2017
Inpatient Physical Therapist
Palm Garden Rehab
01.2010 - 01.2013
Acute Care
University of Florida Shands Hospital
01.2009 - 01.2010
Pediatrics
Levy County School System
01.2009 - 01.2010
Outpatient Physical Therapist
Memorial Hospital West
01.2008 - 01.2009
Master of Business Administration - undefined
Western Governors University
Doctor of Physical Therapy - Physical Therapy
Nova Southeastern University
Bachelor’s - Health Science
Florida International University
- Lymphedema Certified - Academy of Lymphatic Studies-2007
- Certified Specialist in Geriatric - ABPTS Board Certified Specialist - 2014
- Cardiopulmonary resuscitation - American Heart Association-2021
- Credentialed Clinical Instructor Program - American physical Therapy Association-2014
Similar Profiles
Julio RodriguezJulio Rodriguez
Operations Expert at Simply Healthcare PlansOperations Expert at Simply Healthcare Plans
LUDMILA JIMENEZLUDMILA JIMENEZ
Benefits Consultant at Simply Healthcare Plans Inc.Benefits Consultant at Simply Healthcare Plans Inc.
Avilio Lamothe EspinoAvilio Lamothe Espino
Certified Medical Coder at Simply Healthcare Plans Inc.Certified Medical Coder at Simply Healthcare Plans Inc.