Kelli Santos

Case manager serving Medicare Advantage recipients admitted to a skilled nursing facility. Onsite at several skilled facilities, provides authorizations, performs utilization review, authorizes bed days, reviews documentation, provides referrals and assists in discharge planning. Provides education and answers questions regarding insurance benefits. Maintained accurate records of assessments, care plans and interventions aligning with MCG guidelines to support compliance with healthcare regulations.

• Participated in interdisciplinary care conferences to discuss patient care plans and referrals.
• Sustained quality standards by performing routine medication audits and upholding internal and industry best practices.
• Serve as a liaison between residents, families and healthcare providers to ensure that residents' preferences and rights are respected, and that they reive appropriate and ethical care.
• Prepare residents and their families for transitions, whether returning home or moving to another care setting by arranging follow up appointments, overseeing arranging services such as home healthcare and medical equipment.

Case manager of the hospitalized heath plan member providing on site support, patient advocacy, care coordination, utilization review, and discharge planning at assigned area hospitals.

• Worked with medical teams, patients and families to implement effective treatment plans.
• Managed caseload to satisfy multiple patients with diverse needs.
• Utilization review, assessing the medical necessity and continued stays to ensure compliance with the insurance coverage criteria. Conduct concurrent reviews during patient's hospitalization to justify ongoing treatments and length of stay. Daily meeting with medical director and attending physician.
• Maintained detailed records of patient progress, documentation of services and case notes.
• Participated in interdisciplinary care conferences to discuss patient care plans and referrals.
• Discharge planning: facilitating timely and safe discharge by arranging post hospital services, such as rehabilitation, home healthcare and medical equipment.

• Serve as a staff nurse, preceptor, and relief charge nurse on a 26 bed Intermediate care unit consisting of a variety of patients including trauma, cardiac, post operative, renal, neuro and ventilator dependent patients.
• Collaborate with physicians, therapists, nurses, pharmacists, case mangers and other members of the care team to ensure optimal treatment, recovery, education and safe transition from hospitalization.
• Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.