Linda Diaz-Roe
Glendale,AZ
Summary
Hands-on professional proudly offering more than 20 years of expertise in nursing field. Well-rounded and personable Utilization Review Nurse talented in reporting, records oversight and performance improvement.
Overview
13
13
years of professional experience
Work History
Utilization Review Coordinator
Physicians Review Group
Phoenix
08.2023 - Current
- Contributed to the development of policies and procedures related to utilization management, ensuring alignment with industry best practices.
- Devise or identify solutions for irregular requests and issues.
- Supervised and maintained all utilization review documentation through word document
- Managed complex cases involving multiple medical conditions, coordinating care among various specialists while adhering to strict timelines for decision making.
- Evaluated medical necessity criteria using evidence-based guidelines to ensure that services provided were both clinically appropriate and costeffective.
- Performed prior authorization review of services requiring notification.
- Enhanced patient care quality by conducting thorough utilization reviews and coordinating with healthcare providers.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
Patient Care Coordinator
WithHealth, Inc.
Smyrna, GA
01.2022 - 01.2023
- Provided exceptional customer service by addressing concerns, answering questions, and ensuring patient satisfaction with their care experience at the clinic.
- Assisted patients with completing necessary paperwork and forms to provide healthcare facilities with essential information to bill for services.
- Monitored patient health records for accuracy to meet compliance with healthcare guidelines.
- Worked closely with patients to deliver excellent and direct individualized patient care.
- Delivered prompt service to prioritize customer needs.
- Conducted COVID testing via telehealth for various production companies.
- Maintained patient scheduling for telehealth appointments.
- Input test results for patient records.
- Input new patient information.
Triage Medical Assistant
Pain Consultants Of Arizona
Phoenix, AZ
11.2011 - 01.2022
- Contributed to the overall success of the clinic by consistently meeting quality standards in patient care and documentation requirements.
- Answered patient calls regarding medications, post procedure concerns, appointment scheduling, medication side effects, etc.
- Helped improve patient outcomes by educating and advising on relevant treatments and care.
- Enhanced patient care by assisting physicians in examinations, diagnostic tests, and treatment plans.
- Called and faxed pharmacies to submit prescriptions and refills.
- Provided compassionate support to patients experiencing pain or distress while awaiting further medical attention.
- Taught patients about medications, procedures, and care plan instructions.
- Collected and documented patient medical information such as blood pressure and weight.
- Obtained and documented patient medical history, vital signs and current complaints at intake.
- Measured patient pulse oximetry.
- Ensured proper handling of confidential information by maintaining strict compliance with HIPAA regulations and clinic privacy policies.
- Documented vital signs and health history for patients in clinic
- Exhibited strong interpersonal skills while interacting with diverse patient populations, fostering a welcoming and supportive environment for all individuals seeking medical care.
- Assisted physicians with minor surgeries, including preparing operating room and sterilizing instruments.
- Scheduled appointments, registered patients, and distributed sample pharmaceuticals as prescribed.
- Conducted thorough pre-screening evaluations for incoming patients, ensuring accurate data collection for optimal treatment decisions.
- Implemented care and efficiency improvements to support and enhance office operations.
- Collaborated with medical and administrative personnel to maintain patient-focused, engaging and compassionate environment.
- Reduced wait times for patients by maintaining an organized triage system that prioritized based on urgency levels.
- Improved team efficiency by effectively collaborating with medical professionals during high-pressure situations, ensuring seamless patient care.
- Cultivated strong relationships with colleagues across departments to foster a collaborative working environment conducive to efficient patient care delivery.
- Supported clinic administration tasks such as scheduling appointments, updating patient records, and coordinating referrals to specialists when necessary.
- Directed patients to exam rooms, fielded questions, and prepared for physician examinations.
- Explained procedures to patients to reduce anxieties and increase patient cooperation.
- Demonstrated excellent problem-solving skills when addressing complex patient concerns or navigating unexpected challenges during shifts.
- Worked well in a team setting, providing support and guidance.
Education
Medical Assistant
Pima Medical Institute
Mesa, AZ 05.2004
Skills
- Time Management
- Instructional Material Development
- Health Information Systems
- Goal Setting
- Quality Assurance Controls
- Schedule Management
- Records analysis
- Drug utilization review
- Problem-Solving
- Multitasking Abilities
- Regulatory Requirements
Timeline
Utilization Review Coordinator
Physicians Review Group
08.2023 - Current
Patient Care Coordinator
WithHealth, Inc.
01.2022 - 01.2023
Triage Medical Assistant
Pain Consultants Of Arizona
11.2011 - 01.2022
Medical Assistant
Pima Medical Institute