Kathryn Clark
Savannah,GA
Summary
Committed physical therapist with 20+ years of clinical experience, case coordination and claims analysis in orthopedic and neurologic populations and 6+ years experience as utilization review senior analyst of utilization review authorizations, seeking Return to Work/Worker's compensation claims representative role to use my claims management skills, injury investigation and clinical reasoning to review, investigate, analyze and process claims while adhering to system/policy guidelines for management of injury, loss and claims resolution.
Overview
14
14
years of professional experience
30
30
Wellness industry experience
1
1
Certificate
Work History
Physical Therapy Supervisor
Tenet Healthcare
Hardeeville, SC
02.2024 - Current
- Evaluation of functional limitations and developed appropriate treatment plan and discharge plan while following clinical practice guidelines.
- Monitored quality performance indicators for utilization review activities related to clinical outcomes, safety, timeliness, efficiency, effectiveness and patient satisfaction scores.
- Monitored utilization review activities for appropriateness of services provided by physical therapists.
- Instructed patients in proper use of equipment and therapeutic exercises.
- Demonstrated safe techniques for handling and positioning patients during exercise or therapy sessions.
- Completed charge entry and reconciliation with correlation of charges with clinical documentation for accuracy and intermittent audits with education for documentation strategies for medical necessity and justification.
Personal Injury Claims Analyst
The Trauma Experts
Denver, CO
01.2024 - Current
- Investigated, gathered and analyzed evidence related to injury claims.
- Reviewed medical records to determine claim value drivers
- Reviewed medical records to assess the validity of injury claims.
- Researched applicable state laws related to injury claims processing.
- Provided support in all phases of pre-litigation investigations including collecting evidence from various sources.
- Presented findings related to investigation into injury claims during meetings with management staff.
- Identified opportunities for process improvements across the organization.
- Maintained accurate records of all data collected during analysis processes.
Clinical Coordinator
Rehab without Walls
Savannah, GA
03.2014 - 03.2024
- Provided case management/clinical care coordination and interdisciplinary support for the delivery of rehabilitation services for Worker's compensation catastrophic cases, TBI, SCI and complex orthopedic trauma.
- Injury investigation with mechanics and environmental factors for determination of MOI and prevention
- Collaboration with interdisciplinary teams to develop individualized care plans, discharge planning, and ensure the provision of high-quality patient care.
- Utilized strong organizational and communication skills to facilitate seamless transitions between health care settings.
- Managed budget limitations for DDSN funding and case management to provide medically necessary care.
- Coordinated care and services for patients, ensuring that all aspects of their rehabilitative care are addressed including physical, social and emotional with plans of care including enrichment activities, community re-integration, and recreational activities.
- Collaboration with healthcare providers, therapists, physicians, nurses, nurse case managers, and caregivers to ensure effectiveness of treatment plan and progression within continuum of care.
- Engagement with marketing, executives, patients and families as well as organize team/family conferences for weekly/ monthly progress reporting.
- Monitored progress of injured workers through medical treatment, rehabilitation and job retraining programs.
Utilization Review Senior Analyst
Evicore
Savannah, GA
07.2017 - 02.2024
- Clinical reviewer for prior authorization and retrospective requests with review of physical therapy and occupational therapy clinical information to support medically necessary services as well as daily provider interaction with peer-to-peer discussion for reconsideration and appeal
- Proficient with reconsiderations and appeals, active member of complex case management and troubleshooting teams for quality concern issues
- Capitalizing on my ability to connect with team members to improve processes, efficiency and provider experiences
- Provider Outreach Project team member focusing on provider engagement with education for improved use of the web for process initiation and review
- Adhered to current clinical practice guidelines for medically necessary services, quality of care standards and compliance
- Provided proactive management of acutely and chronically ill patients with the objective of improving quality outcomes
- Provided feedback to treating clinical staff and support staff and education regarding authorization and decision process
Director of Rehab/Therapy Program Manager
Heritage Healthcare/Genesis Rehab
Savannah, GA
07.2010 - 05.2014
- Rehab Director for retirement community with Independent Living, Assisted Living, Memory Care and Skilled Nursing in Health Center setting
- Daily duties with 50% management and community relations and 50% patient care overseeing rehab staff and day to day interactions with the rehab leadership team
- Responsible for overseeing all aspects of clinical programs - such as staffing, patient assignment, utilization reviews, established strong working relationship between therapy staff and nursing
- Increased therapy caseload by 40% with screening tools and marketing
- Oversaw provision of skilled therapy services to patients requiring rehabilitation to regain their maximum level of function for an effective discharge
Education
Masters of Science - Physical Therapy
Georgia Southern University Armstrong
Bachelor of Science - Physical Therapy
Georgia Southern University Armstrong
Bachelor of Science - Health Science Health Care Administration
Georgia Southern University Armstrong
Skills
- Workers compensation care coordination
- Orthopedic Rehabilitation
- Neurological Rehabilitation
- Utilization review for medical necessity
- Analytical skills for case review and audits
- Process Improvement/Management
- Budget and funds management
- Claims management
- Microsoft Office proficiency
- Critical Thinking/Problem Solving
- Fraud/Waste Prevention
- Conflict Resolution
- Accountability and Teamwork
- Engaging educator
- Collaborative lifelong learner
- Insurance Practices
- Claim Value Determination
- Professional Communication
- Data Analysis
- Medicare, Medicaid, Worker's Compensation Insurance experience
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Physical Therapy Supervisor
Tenet Healthcare
02.2024 - Current
Personal Injury Claims Analyst
The Trauma Experts
01.2024 - Current
Utilization Review Senior Analyst
Evicore
07.2017 - 02.2024
Clinical Coordinator
Rehab without Walls
03.2014 - 03.2024
Director of Rehab/Therapy Program Manager
Heritage Healthcare/Genesis Rehab
07.2010 - 05.2014
Masters of Science - Physical Therapy
Georgia Southern University Armstrong
Bachelor of Science - Physical Therapy
Georgia Southern University Armstrong
Bachelor of Science - Health Science Health Care Administration
Georgia Southern University Armstrong
Certification
- GA PT 007822
- SC PT 5096
- Lean Six Sigma Yellow Belt Certification
- OSHA Ergonomics Certification
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