Grace Thornton

• Managed and motivated 15 employees to be productive and engaged in work.
• Accomplished multiple tasks within established timeframes.
• Maintained a professional, organized, and safe environment for employees and patrons.
• Resolved staff member conflicts, actively listening to concerns and finding appropriate middle ground.
• Monitored and analyzed business performance to identify areas of improvement and make necessary adjustments.
• Manages quality improvement, resource management, cost containment, case management, and member and provider grievance resolution

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• Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals, and identifying insurance coverage limitations.
• Effectively communicated with physicians regarding patient needs, performance, medications, and changes.
• Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
• Responded promptly and professionally to patient questions and concerns.
• Coordinated with interdisciplinary professionals to develop plans of care, administer tests and monitor patient status.
• Created individualized care plans based on nursing diagnosis and incorporated appropriate nursing methods to achieve positive outcomes.
• Directed and supervised a team of 9 engaged in Case Management development.

• Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.
• Monitors and evaluates care to ensure costs are medically necessary, provided the least expensive setting, and are generated according to governmental and regulatory agency standards
• Work with governmental and commercial payors to provide clinical information needed to approve initial and concurrent stays in medical facilities.
• Skilled at working independently and collaboratively in a team environment
• Managed time efficiently in order to complete all tasks within deadlines
• Excellent communication skills, both verbal and written

• Communicated with healthcare team members to plan, implement and enhance treatment strategies.
• Assessed appropriateness of behavioral patients' continued stay based on Milliman criteria.
• Acted as a patient advocate while evaluating medical necessity, appropriateness, and efficiency of health care services, procedures, and facilities under provisions of applicable health benefits plan.
• Efficiently completed denial reviews for appeal process in accordance with payors policy.
• Self-motivated, with a strong sense of personal responsibility