Marnel Saavedra
Hemet,CA
Summary
Results-oriented case manager with expertise in prior authorization and chronic disease management. Committed to enhancing patient outcomes through effective collaboration and tailored service plans.
Overview
19
19
years of professional experience
Work History
Case Manager
Insight Global Staffing
Los Angeles, CA
02.2024 - Current
- Coordinated client assessments to identify needs and develop tailored service plans.
- Monitored client progress and adjusted support strategies to ensure optimal outcomes.
- Facilitated communication between clients, service providers, and community resources.
- Documented case notes accurately in compliance with regulatory standards and best practices.
Assistant Utilization Management Manager
UCLA Health
Los Angeles, CA
05.2021 - 01.2024
- Collaborated with cross-functional teams to implement new health initiatives, improving patient outcomes and satisfaction rates.
- Directed operational strategies to enhance patient care efficiency and service delivery across multiple departments.
- Analyzed workflow processes, identifying areas for improvement that streamlined operations and reduced costs.
- Mentored staff on best practices, fostering a culture of continuous improvement and professional development.
- Developed training programs for team members, increasing competency in clinical procedures and compliance standards.
After Hours Triage Nurse
Monarch HealthCare
Irvine, CA
07.2007 - 04.2023
- Assessed patient conditions and prioritized care based on urgency and clinical guidelines.
- Collaborated with interdisciplinary teams to develop effective patient care plans.
- Utilized electronic health record systems for accurate documentation and tracking of patient information.
- Educated patients and families on treatment options and post-care instructions to enhance understanding.
- Led initiatives to enhance communication between departments, improving overall patient satisfaction scores.
- Counseled patients via telephone according to established guidelines and protocols, advising on provider-established plans of care.
- Maintained accurate patient records, ensuring thorough documentation of triage assessments and treatment plans.
Prior Authorization Nurse
Regal Medical Group
San Bernardino, CA
08.2007 - 08.2013
- Evaluated prior authorization requests for medical services, ensuring compliance with insurance policies.
- Collaborated with healthcare providers to gather necessary documentation for approval processes.
- Streamlined workflows by implementing best practices in prior authorization procedures.
- Trained and mentored junior nursing staff on effective prior authorization techniques.
- Reviewed complex cases, providing expert recommendations to optimize patient care outcomes.
- Enhanced patient care by assessing insurance coverage and obtaining prior authorization for medical procedures.
- Expedited urgent requests for prior authorization, ensuring timely access to critical medical treatments.
- Collaborated with healthcare providers to ensure accurate submission of required documentation for timely authorizations.
- Participated in interdisciplinary team meetings, collaborating with other healthcare professionals to ensure seamless coordination of care for patients requiring prior authorizations.
- Mentored new hires within the team, sharing expertise in navigating complex insurance guidelines and best practices for managing workflow efficiently.
- Worked closely with case managers to facilitate appropriate utilization of healthcare resources through the prior authorization process.
Education
Associate of Science - Nursing
Long Beach City College
Long Beach, CA05-1994
Skills
Inpatient Case Management
Ambulatory Case Management
Chronic Disease Case Management
Prior Authorization
Appeals processing
Claims Review
Utilization review
Denial Letter Processing
Third party liability
Stop Loss Coverage
Children's services coordination
Staff training management
Timeline
Case Manager
Insight Global Staffing
02.2024 - Current
Assistant Utilization Management Manager
UCLA Health
05.2021 - 01.2024
Prior Authorization Nurse
Regal Medical Group
08.2007 - 08.2013
After Hours Triage Nurse
Monarch HealthCare
07.2007 - 04.2023
Associate of Science - Nursing
Long Beach City College
Foreign Languages
Bilingual in English and Spanish
State Licenses
California
Arizona
Nevada
North Carolina
Texas