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.
2021.10 - 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.
2017.01 - 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
2014.01 - 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
2013.01 - 2017.01
- 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
2010.01 - 2013.01
- 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
2009.01 - 2010.01
- 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
2009.01 - 2010.01
- 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
2008.01 - 2009.01
- 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.
2021.10 - Current
Utilization Management Senior Physical Therapist
Simply Healthcare Plans Inc.
2017.01 - Current
Lab Assistant- Neuromuscular Systems I, II, III
Nova Southeastern University
2014.01 - Current
Inpatient Physical Therapist
Bay shore Pointe Nursing Home and Rehab Center
2013.01 - 2017.01
Inpatient Physical Therapist
Palm Garden Rehab
2010.01 - 2013.01
Acute Care
University of Florida Shands Hospital
2009.01 - 2010.01
Pediatrics
Levy County School System
2009.01 - 2010.01
Outpatient Physical Therapist
Memorial Hospital West
2008.01 - 2009.01
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
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