Kolleen Young

Documented utilization review activities, findings, and decisions in patient records and databases.

• Conducted comprehensive reviews of patient records for medical necessity and compliance with healthcare standards.
• Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system effectively.
• Coordinated with insurance providers to secure authorizations for necessary services.
• Assessed medical records to evaluate appropriateness of requested services and procedures.
• Applied clinical judgment to research cases for accurate determinations.
• Performed pre-certification, concurrent, and retrospective reviews of inpatient and outpatient services.
• Maintained strict adherence to HIPAA regulations to protect patient data.
• Coordinated medical services between primary care providers, specialists, hospitals and outpatient clinics.
• Developed discharge plans for patients transitioning from acute care settings to home or alternate facilities.
• Maintained accurate documentation of patient progress in the electronic health record.
• Communicated regularly with family members regarding patient care needs and progress toward goals.
• Ensured compliance with regulatory standards concerning utilization review, ethical decision making and legal aspects of case management practice.
• Provided emotional support and counseling to patients dealing with chronic illness or end-of-life issues.
• Facilitated transitions between levels of care through effective coordination of resources within a managed care environment.