KAY BLOCK
Grand Rapids,MI
Summary
Dynamic healthcare professional with extensive experience in conducting medical necessity reviews for skilled nursing facilities (SNF), inpatient rehabilitation facilities (IRF), and long-term acute care (LTAC) prior authorization requests. Proficient in applying CMS criteria and InterQual standards to ensure accurate processing of authorizations while effectively communicating determinations to providers and members. Strong collaborator, working closely with the Medical Director team to facilitate timely member transitions and uphold high standards of care. Committed to continuous learning through participation in team huddles and MD rounds, leveraging tools such as Microsoft Teams and email for seamless communication and alignment with evolving processes and directives.
Overview
32
32
years of professional experience
1
1
Certification
Work History
Pre-service Coordinator
Optum - Home and Community
04.2025 - Current
- Assessed patient needs and implemented tailored interventions to improve health outcomes.
- Monitored patient progress and adjusted care strategies based on clinical evaluations.
- Managed high-risk cases proactively, addressing potential complications before they escalated.
- Streamlined case management processes by implementing efficient communication strategies among team members.
- Evaluated medical necessity for requested services, ensuring alignment with established guidelines and protocols.
- Ensured timely and accurate documentation of patient data, maintaining compliance with regulatory requirements.
- Maintained up-to-date knowledge on relevant policies, procedures, regulations, and industry trends through continuing education opportunities.
Home Health Care Coordinator
Optum Health
02.2022 - 04.2025
- Ensure Home Health alignment with CMS Guidelines and InterQual Criteria.
- Collaborate with patients' health care teams to establish an optimal discharge and ensure Home Health needs are met.
- Give case presentations at MD rounds as learning opportunities for my team.
- Provide Quality Improvement ideas and solutions.
- Serve as a resource for other colleagues.
Skilled Inpatient Care Coordinator
Optum Health/Navihealth
07.2019 - 01.2022
- Facilitated on-going assessment of patient and family needs and oversaw implementation of interdisciplinary team plan of care.
- Participated in clinical reviews and audits as related to CMS guidelines for SNF and IRF.
- Assisted in the development of discharge plans for clients transitioning to the next level of care.
- Collaborated with physicians, nurses, therapists, and social workers to provide comprehensive care for patients.
- Maintained communication between families and caregivers regarding the patients' conditions.
Manager and Lead PT, Home Health
Clark At Home/Atrio
04.2016 - 11.2021
- Delivered personalized care in independent living, assisted living, and memory care settings.
- Played a key role in the successful merger of three organizations into Atrio Home Care.
PT Director
SNF, Sanctuary at McAuley | Select Rehab
12.2017 - 12.2019
- Spearheaded a dedicated team of three Physical Therapist Assistants (PTAs) while providing top-tier therapeutic care for a diverse range of patient diagnoses.
- Comprehensive expertise in care planning and discharge preparation ensured optimal patient outcomes and smooth transitions.
- Fostered a collaborative environment that enhances patient care and elevates team performance through weekly Interdisciplinary Team (IDT) rounds.
- Served as clinical instructor for aspiring PT students.
Lead Therapist
Heartland Health Care Center
09.2015 - 03.2016
- Effectively assisted patients in meeting their physical therapy goals despite limited rehab equipment.
- Responsible for all patient documentation and the delegation of tasks to PTAs, ensuring accuracy and efficiency in patient care.
Home Physical Therapy
Residential Home Health
09.2013 - 08.2015
- Provided Home Physical Therapy in West Michigan area to a wide variety of diagnoses including neurologic, orthopedic and general deconditioning after hospitalization.
- Emphasis on re-integration to community and home while reducing hospital readmissions and fall risk reduction.
Manager and Lead PT, Acute Care
Butterworth Campus
04.1996 - 08.2013
- Clinical leadership role in acute care/trauma with an emphasis on neurologic, cardiothoracic, vascular, and ICU/trauma diagnoses.
- Responsible for staff orientation, Joint Commission (JCAHO) compliance, continuity of care and patient satisfaction as the team lead therapist for the launch of heart and lung transplant programs.
Lead PT
Kent Community Hospital
07.1993 - 03.1996
Education
Occupational Safety and Health -
Grand Valley State University
MPT -
University of Michigan
Skills
- Communication skills
- Customer service
- Time management
- Case evaluation
- Healthcare systems navigation
- Care plan development
Certification
- Physical Therapy License
- NDT Certification
- CPR Certification
Timeline
Pre-service Coordinator
Optum - Home and Community
04.2025 - Current
Home Health Care Coordinator
Optum Health
02.2022 - 04.2025
Skilled Inpatient Care Coordinator
Optum Health/Navihealth
07.2019 - 01.2022
PT Director
SNF, Sanctuary at McAuley | Select Rehab
12.2017 - 12.2019
Manager and Lead PT, Home Health
Clark At Home/Atrio
04.2016 - 11.2021
Lead Therapist
Heartland Health Care Center
09.2015 - 03.2016
Home Physical Therapy
Residential Home Health
09.2013 - 08.2015
Manager and Lead PT, Acute Care
Butterworth Campus
04.1996 - 08.2013
Lead PT
Kent Community Hospital
07.1993 - 03.1996
MPT -
University of Michigan
Occupational Safety and Health -
Grand Valley State University