LaTanja Manson

Appeals and Denials Coordinator

-Ensure timely processing of all denial-related and member-oriented written communications from Optum

-Document and communicate appeal and denial information via fax, email, or portals including appeal and denial letters, NOMNC letters, AOR forms and clinical information

Responsible for reviewing pre-authorization requests for skilled nursing and rehabilitative services and determining if requests meet medical necessity for the requested level of care. Coordinated the transition of patients from the community or acute setting to the next appropriate level of care while following the established facility policies and procedures.

-Performed a hybrid role for all prospective, concurrent and retrospective requests within established parameters.

-Coordinated peer to peer reviews with Medical Directors

-Perform other duties and responsibilities as required, assigned or requested

-Completed weekly assessments and engaged the PAC inter-disciplinary care team providing them with the Outcomes Prediction Tool (OPT) to align expectations for discharge planning.

-Engaged patients and families to share information and facilitate informed decisions. By serving as the link between patients and the appropriate health care personnel.

-Ensured an efficient, smooth, and prompt transition of care.

• Championed evidence-based practices within the department, ensuring adherence to industry standards and best practices.
• Committed to ongoing professional development within the field of rehabilitation science; staying current on research trends, new treatments and technologies.
• Implemented data-driven performance metrics to monitor the effectiveness of rehab services and inform continuous improvement efforts.
• Achieved higher rates of successful discharges from rehabilitation program through individualized treatment plans and goal setting that address each patient''s unique needs and circumstances.
• Optimized budget management, reallocating funds to areas of greatest impact on patient care.
• Mentored junior staff members, cultivating a culture of learning and professional growth within the team.
• Developed targeted marketing initiatives to raise awareness about available rehab services, increasing community engagement and referrals from local healthcare providers.
• Facilitated cross-departmental communication for coordinated care planning and seamless transitions between levels of care for patients.
• Ensured appropriate staffing levels and scheduling to optimize both patient care and staff morale.
• Developed interdisciplinary collaboration for improved patient care and streamlined service delivery.
• Fostered a culture of collaboration, respect, and open communication within the department, resulting in improved staff satisfaction and performance.
• Improved overall patient satisfaction with rehab services by addressing concerns promptly and collaboratively developing solutions.
• Increased staff retention by fostering a supportive work environment and providing professional development opportunities.
• Led successful accreditation reviews, showcasing departmental excellence in compliance with regulatory requirements.
• Maintained appropriate and adequate staffing and scheduling of residents on caseloads.
• Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
• Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.