JESSANDRA HIGHTOWER
Pine Bluff,AR
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
9
9
years of professional experience
Work History
Director of Utilization Review
Conway Behavioral Health
Conway, AR
02.2025 - Current
- Referred cases to secondary review for failure to meet criteria.
- Managed changes in integrated health care delivery systems and technological innovations while keeping focus on quality of care.
- Participated in multidisciplinary team meetings to discuss patient care issues and utilization review findings.
- Trained new employees on utilization review processes and regulations.
- Analyzed utilization data to identify patterns and make recommendations for cost-effective care delivery.
- Ensured compliance with federal, state, and accreditation requirements related to utilization management.
- Educated healthcare providers on utilization review processes, criteria, and best practices.
- Provided input into process improvement initiatives designed to enhance efficiency in the Utilization Review Department.
Utilization Review Specialist
Jefferson Regional Specialty Hospital
White Hall, AR
08.2024 - 02.2025
- Provided consultation on appropriate use of services to staff members including utilization management strategies.
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
- Documented all utilization review activities, findings, and decisions in patient records and databases.
- Conducted concurrent reviews to monitor the ongoing appropriateness of services provided to members.
UTILIZATION REVIEW SPECIALIST
University of Arkansas for Medical Sciences
Little Rock, AR
08.2021 - 08.2024
- Monitored medical services to assess the quality of care and the appropriate allocation of resources
- Supplied information relating to plan of care, regulatory requirements, and benefits management by communicating and collaborating with third-party payers
- Coordinated service of highly complex cases by collaborating with case managers, behavioral health systems, early intervention, and Medicaid
- Collaborated with physicians, nurses, case managers, discharge planners, social workers and other healthcare professionals to develop a comprehensive plan of care within specified guidelines.
- Interpreted coverage policies and benefit provisions as they relate to the clinical setting.
- Participated in interdisciplinary team meetings to discuss complex cases or those requiring an alternative treatment plan or continued stay evaluation.
- Works with state and federal representatives to ensure departmental compliance with utilization review regulations.
PROGRAM ELIGIBILITY SPECIALIST
Arkansas Department of Human Services
Little Rock, AR
12.2015 - 08.2021
- Performed intake and assessment for new applicants for financial and health care programs to determine eligibility for services
- Interviewed benefits recipients at specified intervals to certify eligibility for continuing benefits
- Informed individuals about the eligibility requirements, applications processes and payment procedures for the benefits program
- Investigated applicants seeking public assistance to collect data relevant to their applications
- Interpreted policy and ensures compliance with state and federal laws, regulations, legal mandates, action plans, and policies.
- Participated in trainings aimed at improving knowledge of applicable laws and regulations governing program eligibility.
- Prepared presentations summarizing current trends in program enrollment or eligibility requirements.
Education
Master of Science - Clinical Psychology
Capella University
Minneapolis, MN05-2018
BACHELOR OF ARTS - INTERDISCIPLINARY STUDIES -
University of Arkansas at Little Rock
Little Rock, AR05.2015
Skills
- Medicaid Knowledge
- Utilization Review
- Interpersonal and Written Communication
- Documentation and Reporting
- HIPAA Compliance
- Data analysis
Timeline
Director of Utilization Review
Conway Behavioral Health
02.2025 - Current
Utilization Review Specialist
Jefferson Regional Specialty Hospital
08.2024 - 02.2025
UTILIZATION REVIEW SPECIALIST
University of Arkansas for Medical Sciences
08.2021 - 08.2024
PROGRAM ELIGIBILITY SPECIALIST
Arkansas Department of Human Services
12.2015 - 08.2021
Master of Science - Clinical Psychology
Capella University
BACHELOR OF ARTS - INTERDISCIPLINARY STUDIES -
University of Arkansas at Little Rock