Mary J. Wolfe
Selma,USA
Summary
Dynamic professional with extensive hands-on experience in Utilization Review and a proven ability to navigate complex challenges. Strong problem-solving skills and a proactive approach to new tasks drive consistent results, while adaptability and creativity enhance overall effectiveness. A unique skill set developed through diverse roles in Public Health, CCS Case Management, CPS Social Work, Forensic Interviewing, Home Health, Rural Health, Women's Health, Pediatrics, Skilled Nursing, Assisted Living, and RN Utilization Case Management contributes to a comprehensive understanding of various healthcare environments. Committed to making meaningful contributions that advance organizational goals and improve patient outcomes.
Overview
30
30
years of professional experience
Work History
RN Utilization Review Case Manager
Molina Healthcare
11.2016 - Current
- Experienced RN Utilization Review Case Manager with expertise in patient medical record analysis and healthcare expenditure assessment. Skilled in discharge planning and admission coordination, ensuring seamless transitions for patients. Strong communicator and empathetic listener, adept at presenting cases to multi-disciplinary teams. Committed to delivering high-quality patient care and fostering collaborative relationships.
- Collaborated with interdisciplinary teams to develop comprehensive care plans for complex cases.
- Trained new Hires, raising team's overall competency and service delivery standards.
- Proficient in the use of InterQual and Milliman Care Guideline
Home Health Marketer
Valley Home Health
11.2015 - 11.2016
- promoted advantages of home health to primary care physicians, skilled nursing facilities, and assisted living.
- Researched and evaluated potential new markets
Admission Coordinator
Palm Village Retirement Community
Reedley, CA
01.2014 - 11.2016
- Market and admit patients from a hospital or from home for Skilled Nursing or Long-term care
- Confirmed all insurance benefits met standards of admissions as dictated by policy.
- Collaborated with healthcare providers to assess prospective residents' needs.
- Managed admissions processes for incoming students, promptly collecting and processing necessary documents.
- Streamlined admissions process, enhancing efficiency and resident experience.
Child Protective Services Social Worker
Merced County Child Welfare
10.2009 - 10.2016
- Family Maintenance Social Worker, Forensic interviewer
- Conducted comprehensive assessments to determine child welfare needs and risks.
- Developed and implemented individualized service plans for at-risk families.
- Facilitated family counseling sessions to support reunification efforts.
- Monitored compliance with state regulations and agency policies.
- Facilitated successful reunification's by monitoring progress and adjusting case plans as needed.
- Advocated for the best interests of children during court hearings and collaborated with legal representatives on case matters.
Education
Bachelor's Degree - Social work
California State University Fresno
Registered Nurse - undefined
Alan Hancock College
Vocational Nursing - undefined
Merced College
Skills
- Patient Assessment Skills
- Discharge planning
- Analytical Decision making
- Relationship building and Teamwork
- Works in Medi-cal/Medicaid environment
- Attention to detail: Ensures precision when reviewing cases and documentation
- Effective communication: Clearly conveying findings and recommendations to healthcare teams and insurers
- Collaboration: Working effectively with providers, payers, and care coordinators to optimize patient outcomes
- Utilization management expertise: Evaluating healthcare services to ensure care complies with policy guidelines and resources are used optimally
- Knowledge of medical coding and documentation: Familiarity with CPT, ICD-10, and HCPCS codes and key payer rules
- Technology literacy: Proficiency with EMRs, UR software, and decision-support systems like InterQual or MCG
- Medication and IV administration
- Direct patient care
- Patient assessments
- Documentation and charting
- Strong clinical judgment
COMMUNICATION
- Excellent written and verbal communication skills.
- Confident, articulate and professional speaking abilities.
- Empathetic Listener
Timeline
RN Utilization Review Case Manager
Molina Healthcare
11.2016 - Current
Home Health Marketer
Valley Home Health
11.2015 - 11.2016
Admission Coordinator
Palm Village Retirement Community
01.2014 - 11.2016
Child Protective Services Social Worker
Merced County Child Welfare
10.2009 - 10.2016
Vocational Nursing - undefined
Merced College
Registered Nurse - undefined
Alan Hancock College
Bachelor's Degree - Social work
California State University Fresno