Jennifer Naliboff
Sandy Hook,USA
Summary
Dynamic clinical and program management professional and licensed Physical Therapist, recognized for strong clinical acumen and exceptional computer proficiency. Extensive knowledge of Medicare/Medicaid regulations and the private insurance landscape, complemented by a robust blend of clinical, managerial, and educational expertise across diverse environments. Proven track record in policy writing and development, with experience in teaching, auditing, contract negotiations, provider and member relations, and staff management. Committed to enhancing patient care and operational efficiency through innovative solutions and collaborative leadership.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Clinical Program Manager
Optum Physical Health
Eden Prairie, MN
07.2024 - Current
- Led team in navigating medical management system to enhance resource accessibility and address inquiries.
- Leveraged clinical acumen to guide staff on disease states and health conditions.
- Oversaw coordination of care for chronic conditions, including maintenance therapy and utilization management.
- Assisted in developing and delivering operational and technical training programs.
- Collected and evaluated data to identify clinical best practices, establishing policies and workflows.
- Implemented and managed medical and clinical operation programs to improve efficiency.
- Ensured compliance with regulatory requirements during clinical review and case management processes.
- Oversaw responses to providers and members to guarantee compliance with state and federal regulations.
- Evaluated and identified trends in states, regions, and markets; reported findings to senior management.
- Ensured team education, certification, and licensure requirements remained current.
- Oversaw utilization review determinations by developing auditing tools and key performance indicators.
- Held team accountable to productivity standards while maintaining high-quality review processes.
- Collaborated with health care providers on appropriateness of care and integration of best evidence.
- Conducted quarterly evaluations with team members to discuss performance and professional goals.
- Performed annual reviews for approximately thirty clinicians, discussing merit-based compensation with leadership.
- Assisted in interviewing prospective candidates for clinical roles, addressing staffing needs.
Clinical Quality Analyst, Sr.
Optum Physical Health
Eden Prairie, MN
12.2022 - 07.2024
- Updated Physical Health Medicare job aids in the document management system to maintain compliance.
- Conducted clinical and appeal reviews for Student Resources Program.
- Managed legacy OrthoNet therapy inquiries, including re-exporting authorizations for claims, and creating authorization letters for appeal overturns.
- Facilitated transition of legacy OrthoNet’s web portal to Optum’s database.
- Oversaw daily operations of legacy OrthoNet’s web portal to maintain functionality.
- Transitioned legacy OrthoNet’s policies and procedures to Optum’s Atlas Document Management System, creating essential documentation.
- Collaborated with Compliance Department to analyze data for health plan audits of legacy OrthoNet products.
Medical Management Internal Quality Monitoring Manager
OrthoNet
White Plains, NY
12.2017 - 12.2022
- Assessed operational compliance with contract and program requirements in Medical Management department.
- Implemented audit tools, sampling plans, and reporting criteria to enhance accuracy.
- Oversaw completion of routine status reports as needed.
- Reviewed internal monitoring reports to identify discrepancies and inform corrective actions.
- Presented findings and recommendations to Team Leaders of audited contracts.
- Facilitated necessary corrections and recommended system modifications based on audit results.
- Oversaw additional monitoring and focused audits to maintain compliance standards.
- Recommended improvements in monitored areas while ensuring adherence to best practices.
- Assisted in selecting therapy cases and structuring questions for quarterly clinical inter-rater evaluations.
- Composed executive summary reports for quarterly clinical inter-raters.
Team Leader/Care Manager
OrthoNet
White Plains, New York
10.2003 - 12.2017
- Managed Physical and Occupational Therapy benefits for insurance contract members, assessing skilled care needs.
- Supervised Care Managers and Case Assistants to enhance team performance.
- Facilitated clinical decision-making among staff members through collaboration.
- Trained new Care Managers on software use, visit request analysis, authorization decisions, and HIPAA compliance.
- Communicated with therapists and doctors regarding patient needs for skilled care.
- Coordinated with billing and insurance staff to resolve authorization, claims, and denial issues.
- Interacted with OrthoNet Medical Directors to clarify surgical procedures or treatment protocols.
- Negotiated rates and established out-of-network contracts with providers.
- Reviewed and prepared files for annual audits conducted by insurance companies.
- Updated clinical criteria based on current evidence-based research findings.
- Assisted in selecting therapy cases and structuring questions for quarterly clinical inter-rater evaluations.
Adjunct Professor
Utica College
Utica, NY
09.2012 - 05.2013
- Delivered online course on Diagnostic Imaging, enabling students to analyze imaging in clinical settings.
- Facilitated weekly asynchronous discussions to enhance application of course material in practice.
- Guided students in integrating diagnostic imaging into evaluations and diagnoses of neuromuscular conditions.
- Supported learning through interactive content and prompt feedback on assignments.
Physical Therapist
Orthopedic Surgeons of Long Island Associates
New Hyde Park, NY
04.2002 - 10.2003
- Evaluated and treated diverse patients with orthopedic, geriatric, vestibular, and neurologic conditions.
- Collaborated with patients and families to establish treatment goals and develop care plans.
- Supervised Physical Therapists, Assistants, Aides, Athletic Trainers, Students, and Volunteers.
- Documented treatments accurately for insurance reimbursement purposes.
- Educated Physical Therapy and Assistant students during clinical affiliations, ensuring effective learning outcomes.
Education
Doctor of Physical Therapy - Transitional Doctor of Physical Therapy
Utica College
Utica, NY08.2012
Bachelor of Science - Physical Therapy
New York University
New York, NY02.2000
Bachelor of Arts - Psychology
New York University
New York, NY05.1996
Skills
- Clinical program management and oversight
- Policy development and execution
- Quality assurance practices
- Data analysis proficiency and analytical problem solving
- Healthcare coordination expertise
- Patient and provider engagement
- Strong interpersonal communication skills
- Team-oriented leadership and collaboration
- Emotional intelligence and awareness
- Staff management and supervision
- Staff training and development
- Task delegation proficiency
- Talent acquisition and retention strategies
- Proficient in Microsoft Office
Certification
- Physical Therapy License – New York State: 021894
- Physical Therapy License – Connecticut: 013335
- Physical Therapy License – Pennsylvania: PT030076
- InterQual
Certifications
InterQual
HIPPA
Emerging Leaders Program
Medicare & Retirement
Timeline
Clinical Program Manager
Optum Physical Health
07.2024 - Current
Clinical Quality Analyst, Sr.
Optum Physical Health
12.2022 - 07.2024
Medical Management Internal Quality Monitoring Manager
OrthoNet
12.2017 - 12.2022
Adjunct Professor
Utica College
09.2012 - 05.2013
Team Leader/Care Manager
OrthoNet
10.2003 - 12.2017
Physical Therapist
Orthopedic Surgeons of Long Island Associates
04.2002 - 10.2003
Doctor of Physical Therapy - Transitional Doctor of Physical Therapy
Utica College
Bachelor of Science - Physical Therapy
New York University
Bachelor of Arts - Psychology
New York University