Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Erlinda Barr

Los Angeles,CA

Summary

Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.

Overview

11
11
years of professional experience
1
1
Certification

Work History

Case Management Coordinator

Cedars Sinai Med Center
Beverly Hills , CA
02.2000 - 08.2010
  • Cooperated with local service providers, outreach workers, case managers and collaborative agencies to facilitate services for members.
  • Discharge planning, collaborated with contracted HH and DME Providers to provide service in a timely manner
  • Maintained detailed records of all interactions with clients in accordance with HIPAA regulations.
  • Attended trainings and workshops related to case management principles and techniques.
  • Protected patient data in alignment with HIPAA privacy protocols.
  • Completed day-to-day duties accurately and efficiently.

Care Review Clinician

Molina Healthcare
Long Beach, CA
01.2012 - Present
  • Reviewed patient medical records to determine if requested services are medically necessary and appropriate for the diagnosis.
  • Interpreted benefit plans, medical necessity criteria, policy language, and state regulations for proper utilization of services covered under a health plan.
  • Adhered strictly to HIPAA regulations pertaining to protected health information when handling confidential documents related to patient care.
  • Maintained accurate documentation of all prior authorization activities in accordance with established policies and procedures.
  • Provide prior authorization decision after a thorough clinical review
  • Referred members to specialized health resources or community agencies to furnish additional assistance.

Education

Bachelor of Science - Nursing

Our Lady of Fatima University
Manila, Philippines
03-1980

Associate of Science - Medical Secretarial

Perpetual Help College
Manila, Philippines
03-1976

Skills

  • Regulatory Compliance
  • Data Collection
  • Discharge Documentation
  • Effective Customer Communication
  • Documentation
  • Care Coordination
  • Accurate Documentation
  • Patient Relations

Certification

  • LVN License - CA, USA
  • RN License - Manila, Philippines

Timeline

Care Review Clinician

Molina Healthcare
01.2012 - Present

Case Management Coordinator

Cedars Sinai Med Center
02.2000 - 08.2010

Bachelor of Science - Nursing

Our Lady of Fatima University

Associate of Science - Medical Secretarial

Perpetual Help College

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Erlinda Barr