Heather Stargel
Las Vegas,NV
Summary
Highly experienced human service professional. Able to handle a high volume of customer/client caseloads in a fast-paced environment, with minimum supervision, while emphasizing the highest quality of client care and consumer service. Excellent listening skills and oral and written communication. Comfortable in interacting with all levels of the organization and the public. Excellent problem-solving and negotiating skills. Able to make decisions independently and quickly with minimal escalations. Self-motivated professional promoting attention to detail and the drive to resolve issues effectively. Calm and poised in the most stressful environments.
Overview
8
8
years of professional experience
Work History
Director of Utilization Review
Crossroads Of Southern Nevada
Las Vegas, NV
01.2023 - Current
- Developed and implemented utilization review policies and procedures.
- Created a system to track the progress of utilization reviews, ensuring timely completion.
- Monitored quality assurance activities for utilization reviews.
- Coordinated with medical staff, providers, and other healthcare professionals to ensure proper coding and documentation of services provided.
- Conducted regular audits of utilization review processes to identify areas for improvement.
- Analyzed data from utilization management activities to measure program effectiveness.
- Provided guidance on compliance issues related to utilization review regulations.
- Ensured that all utilization reviews adhere to applicable state and federal laws as well as industry standards.
- Collaborated with internal stakeholders to develop strategies for improving patient access to care through the use of evidence-based practices.
- Facilitated communication between providers and payers regarding denials or appeals of claims due to non-compliance with established criteria.
- Evaluated proposed treatments or services based on appropriateness, necessity, clinical efficacy, cost-effectiveness, and medical necessity guidelines.
- Identified potential opportunities for cost savings by analyzing trends in service usage patterns within the organization's network of providers.
- Reviewed requests for authorization using appropriate criteria sets such as InterQual or MCG Care Guidelines.
- Developed reports summarizing results from utilization review activities.
- Participated in interdisciplinary meetings involving case management, social work, physicians, nurses, and other members of the health care team.
- Assessed risk factors associated with overutilization or underutilization of services and resources.
- Trained new employees on utilization review processes and regulations.
Utilization Review Coordinator
Crossroads Of Southern Nevada
Las Vegas, NV Nevada
10.2021 - 12.2022
- Reviewed and evaluated patient information to determine appropriate level of care and services required.
- Conducted utilization review activities including concurrent reviews, retrospective reviews, and discharge planning.
- Assessed the appropriateness of length of stay for inpatient admissions.
- Analyzed medical records to ensure compliance with regulatory requirements.
- Collaborated with multidisciplinary teams to develop strategies for improving quality of care and reducing costs.
- Participated in meetings with health plan representatives regarding utilization management policies.
- Provided training to other staff members on utilization management processes and procedures.
Outpatient Case Manager
Crossroads of Southern Nevada
11.2020 - 10.2021
- Provided direct case management services to clients and their families in an outpatient setting.
- Ensured compliance with all applicable laws, regulations, and standards of practice.
- Developed treatment plans that addressed client needs and identified appropriate resources.
- Conducted assessments of clients' mental health status to determine eligibility for services.
- Coordinated with other providers to ensure continuity of care for clients.
- Assisted clients in identifying and accessing community resources such as housing, food assistance, employment.
- Monitored progress of clients during the course of their treatment plan.
Behavioral Health Technician
American Addiction Centers
12.2017 - 01.2019
- Assessed patient behavior, reactions and responses to treatment plans.
- Facilitated group therapy sessions with multiple patients.
- Monitored patient safety in all areas of the facility.
- Provided crisis intervention services to patients in need.
- Maintained accurate documentation of patient progress and treatments received.
- Educated family members on techniques to support a patient's recovery process.
Clinical Associate
Las Vegas Recovery Center
01.2016 - 12.2017
- Performed laboratory tests such as urinalysis, hematology, and blood chemistry.
- Maintained cleanliness of the clinical environment by sterilizing instruments, cleaning exam rooms and stocking supplies.
- Monitored patient progress, reported changes or concerns to healthcare team members and documented all activities in Electronic Medical Record.
- Ensured compliance with HIPAA regulations by maintaining patient confidentiality during all interactions.
- Collected specimens for testing according to established protocols, prepared specimens for transport to laboratory facilities.
Education
Dual Degree- Master’s in Heath Administration/ Master’s in Business Administration -
University of Phoenix
05.2024
Bachelor of Science in Human Services/ Addiction Specialist -
University of Phoenix
07.2021
GED -
Desert Rose Adult Education
Skills
- Interdepartmental Collaboration
- Health Information Systems
- Documentation Review
- Quality Improvement
- Healthcare operations
- Utilization Management
- Needs Assessment
- Patient transfers and transitions
- Utilization review
- Healthcare regulations
- HIPAA Compliance
- Communication
- Insurance Verification
- Interpersonal and written communication
- Documentation And Reporting
- Records analysis
- Medicaid knowledge
- Interdepartmental Functions Coordination
- Employee Training Program
- Employee Work Scheduling
- Process Implementation
- Problem-solving abilities
- Time management abilities
- Attention to Detail
- Problem-solving aptitude
- Certified in CPR/AED
- Multidisciplinary team collaboration
- Team building
- Teamwork and Collaboration
- Self Motivation
- Effective Communication
- Accreditation Coordination
- Medicaid Provider Enrollment (Nevada)
References
References available upon request.
Timeline
Director of Utilization Review
Crossroads Of Southern Nevada
01.2023 - Current
Utilization Review Coordinator
Crossroads Of Southern Nevada
10.2021 - 12.2022
Outpatient Case Manager
Crossroads of Southern Nevada
11.2020 - 10.2021
Behavioral Health Technician
American Addiction Centers
12.2017 - 01.2019
Clinical Associate
Las Vegas Recovery Center
01.2016 - 12.2017
Dual Degree- Master’s in Heath Administration/ Master’s in Business Administration -
University of Phoenix
Bachelor of Science in Human Services/ Addiction Specialist -
University of Phoenix
GED -
Desert Rose Adult Education
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