Laura French
Willis,TX
Summary
Compact licensure, result driven, solid background in coordination and managing service operations. Proven track record in effective lead/supervision, coordination of care for members with chronic comorbidities, pre-authorization, utilization review, and quality assurance. Highly organized, team-oriented professional with exceptional communication skills and the ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
11
11
years of professional experience
1
1
Certification
Work History
New Member Clinical Coordinator
Community Health Choice
Houston, TX
09.2024 - Current
- Member contact with completion of telephonic HRA, CVA & SDOH assessments.
- Coordinated patient care and services among multidisciplinary teams to ensure comprehensive treatment plans.
- Maintaining highest caseload while ensuring adherence to appropriate guidelines and providing assistance to staff who have ongoing caseloads.
- Serve as subject matter expert in providing support, education as appropriate to other clinical and non-clinical staff.
- Provide feedback to leadership related to performance issues and consult with leadership on actions to improve performance.
- Provide support to staff facilitating healthcare processes, communication and coordination of activities.
- Resolve complaints and issues arising in day-to-day healthcare services and escalation to leadership as needed.
- Liaison for internal and external customers to ensure continuity of healthcare services.
- Maintain a HIPAA compliant work space, with confidentiality, effective workplace relationships and adherence to company code of conduct.
- Attendance and participation in all departmental, company wide, and other work groups,
LTSS Coordinator/Case Manager
Elevance
Houston, TX
06.2017 - 06.2024
- Performed LTSS assessments with creation fo PCSP, DME referrals and upgrade referrals as needed.
- Continuous follow-up per TMHP guidelines to ensure needed services are in place.
- Service authorization creation and processing.
- Resolution of complaints with escalation to leadership when needed.
- Review and audit of Level 1 assessments and processing of packet to ensure all services in place in a timely manner.
- Coordination with multi-discipline healthcare staff along with external agencies and providers to ensure services provided in effective and efficient manner.
- Participated in internal and external audits to ensure compliance with regulatory guideline requirements and company policies.
- Assist with training staff according to healthcare standards, policies and procedures.
- Actively participated in departmental audits for quality improvement.
- Coordination with leadership related to caseload, activity assignment completion, updating of processes and authorizations current.
- Served as subject matter expert to members and clinical staff.
- Case Manager monitoring and facilitating members education and compliance with complex co-morbidities to achieve highest level of functioning.
Pre-Authorization/Utilization Review Nurse
HealthHelp, LLC
Houston, TX
05.2015 - 06.2017
- Conducted comprehensive reviews of patient treatment plans for medical necessity and appropriateness.
- Collaborated with healthcare providers to resolve utilization issues and ensure quality care delivery.
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Reduced unnecessary medical costs, ensuring treatments met established medical guidelines and policies.
- Conducted thorough evaluations of medical necessity for procedures, leading to optimal resource utilization.
Education
No Degree - Marketing/Science
Lamar University
Beaumont, TXAssociate of Science - Nursing
Lamar State College
Port Arthur, TX08-1995
Skills
- Excellent problem solving, critical thinking and organizational skills
- Management of multiple deadlines with ability to prioritized needs
- Conflict resolution and leadership through change
- Process improvement and implementation
- Working knowledge and proficiency with Microsoft Office Suite and other EMR software programs
- Strong written and verbal communication
- Superior work ethics
- High productivity & audit scores
- Maintaining HIPAA compliant work space
- Medicaid and Medicare population experience
- Clinical Experience
- Supervisory/Leadership experience
Certification
- Licensed LVN - 1995
Timeline
New Member Clinical Coordinator
Community Health Choice
09.2024 - Current
LTSS Coordinator/Case Manager
Elevance
06.2017 - 06.2024
Pre-Authorization/Utilization Review Nurse
HealthHelp, LLC
05.2015 - 06.2017
No Degree - Marketing/Science
Lamar University
Associate of Science - Nursing
Lamar State College