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
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.
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
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