Jasmine Graddick
Belleview,FL
Summary
Experienced with managing patient care authorizations and approvals, ensuring compliance and efficiency in healthcare settings. Utilizes strong analytical skills and multidisciplinary collaboration to optimize resource utilization and improve patient outcomes. Knowledge of healthcare regulations and decision-making processes, ensuring effective and informed management of patient care resources.
Overview
14
14
years of professional experience
Work History
Utilization Management Technician
AmeriHealth Caritas
06.2022 - Current
- Reviews patient medical records: Analyzes clinical information, treatment plans, and other relevant data to evaluate the appropriateness and necessity of services.
- Ensures compliance with insurance guidelines: Adheres to pre-authorization and other utilization management requirements set by various payers.
- Maintains accurate records: Keeps detailed and organized records of patient information, utilization reviews, and related documentation within the medical management system.
- Collaborates with healthcare teams: Works closely with physicians, nurses, and other healthcare professionals to address patient needs and ensure optimal care.
- Applies clinical experience, health plan benefit structure, health management policies and procedures, and claims payment knowledge
Personal care connector
Amerihealth Caritas
10.2018 - Current
- The Care Connector is responsible for supporting the daily operations of integrated care management and utilization management program interventions
- The Care Connector performs in a contact center environment, effectively processing calls from Members, Providers and other areas, internal and external to the company
- The CC identifies members with Care Gaps/HEDIS related health conditions and assists them in accessing care through Plan benefits and community resources
- Under the direction of Clinical staff, the Care Connector will provide members with educational materials and carry out strategies to increase health care adherence and reduce barriers to care
Outreach Coordinator
Health Partners Plans
06.2014 - 06.2018
- Reviews and track predetermination status of members to identify appropriate level of intervention required to promote the continuous enrollment of qualified members
- Conducts telephonic outreach to members to educate on important Medicaid eligibility renewal requirements
- Assist members with completing online renewal applications for the Medicaid program to assure compliance with deadlines
- Conduct telephonic outreach to new members to advise them of their benefits;
- Educates members on various programs (through Disease Management and SNU) available to them, if applicable; and ensure that all pertinent documentation (ID cards, handbooks, etc) has been received
- Assists with scheduling PCP visits for some new member populations as mandated by DPW within the appointment Standards
- Maintains accurate record of outbound call attempts, inaccurate telephone numbers, messages left, and successful outreach activities
- Documents call activities in both On Contact and Macess to ensure accurate reporting
- Perform other duties as assigned
Event specialist
Crossmark
04.2014 - 06.2014
- Prepared and set up event tables & communicated the features and benefits of the product
- Prepared and serve food samples
- Maintained a clean, sterile and safe work station using cleaning chemicals
- Maintained a professional appearance consistent with the requirements of the job
- Prepares and submits all on-line requirements on the same day as Event execution
Seasonal Picker
Amazon
11.2012 - 12.2012
- Picked out customer orders on a multi-level mezzanine
- Learned and adhere to strict safety, quality, and production standards
- Received products using radio frequency scanners
- Packed and shipped customer orders
Assistant Manager
Burger King
04.2012 - 08.2012
- Supervised a crew of 15 members and ensured everyone adhered to their daily duties
- Trained new employees by providing knowledge of specific store tasks and policies
- Opened the store and made sure that everything and everyone was in place prior to opening
- Made sure the end of the day closing process was complete and accurate
- Answered any questions related to the store and products while maintaining knowledge of current sales and store promotions
- Communicated with management regarding any issues or concerns that arose throughout the daily work day
Crew Member
Burger King
10.2010 - 01.2012
- Worked as a team member, performing cashier duties, product assistance and cleaning while providing excellent customer service
- Made sure all customers were receiving timely service at all times
- Handled any customer concerns in a professional and courteous manner
- Maintained Cleanliness and presentation of stock room and production floor
Education
High School Diploma -
Samuel Fels High School
Philadelphia, PASkills
- HIPAA compliance
- Insurance verification
- Quality improvement
- Healthcare regulations
- Utilization review
- Medical necessity assessment
- Inpatient care
- Medicaid
- Outpatient care
Timeline
Utilization Management Technician
AmeriHealth Caritas
06.2022 - Current
Personal care connector
Amerihealth Caritas
10.2018 - Current
Outreach Coordinator
Health Partners Plans
06.2014 - 06.2018
Event specialist
Crossmark
04.2014 - 06.2014
Seasonal Picker
Amazon
11.2012 - 12.2012
Assistant Manager
Burger King
04.2012 - 08.2012
Crew Member
Burger King
10.2010 - 01.2012
High School Diploma -
Samuel Fels High School
Similar Profiles
Debra CaldwellDebra Caldwell
Independent Contractor – Member Services at AmeriHealth Caritas Pennsylvania - Medicaid & Keystone First – AmeriHealth Caritas Pennsylvania Community Health Choices – Keystone First Community Health ChoicesIndependent Contractor – Member Services at AmeriHealth Caritas Pennsylvania - Medicaid & Keystone First – AmeriHealth Caritas Pennsylvania Community Health Choices – Keystone First Community Health Choices
Tiesha ReidTiesha Reid
Personal Care Connector at AmeriHealth Caritas of DelawarePersonal Care Connector at AmeriHealth Caritas of Delaware
DAQUICE PEARSONDAQUICE PEARSON
Provider Enrollment Specialist at AmeriHealth CaritasProvider Enrollment Specialist at AmeriHealth Caritas
Timothy DetmanTimothy Detman
Manager, Business Systems Analysis at AmeriHealth CaritasManager, Business Systems Analysis at AmeriHealth Caritas
Clarissa MoralesClarissa Morales
Janitorial Worker at Image Cleaning Services LLC.Janitorial Worker at Image Cleaning Services LLC.