Maya Lupercio
Utilization Management/Managed Care Professional
San Bernardino,CA
Summary
Dynamic and versatile Senior Manager with extensive experience in managed care in an IPA setting, excelling in strategic planning and operations management. Proven track record of enhancing compliance rates and optimizing processes, while leading cross-functional teams. Skilled in data analytics and fostering team development, driving significant improvements in patient-centered care and authorization management.
Overview
8
8
years of professional experience
Work History
Senior Manager, Prior Authorization
Regal Medical Group
San Bernardino, CA
05.2023 - Current
- Managed prior authorization case managers and coordinators,in a high volume setting, in order to promote quality, cost effective medical care through strict compliance to UM policy and procedures.
- Provided direct oversight to a team of 20+ adjudicating an average of 49,000 authorizations per month while maintaining a 98% or higher compliance rate.
- Provided direct oversight to 3 different departments with distinct focuses including, provider customer service, secondary payer insurance, and project management teams.
- Developed and implemented prior authorization policy and plans for effective patient centered utilization management.
- Developed program goals and objectives with medical directors and executive leadership.
- Developed and implemented effective ongoing programs to measure, assess, and improve quality of processes and workflows, treatment and services delivered to patients.
- Oversight of at least 10 open projects for prior authorization and inpatient departments.
- Evaluate staff and determined the quality of their work efforts to provide individualized goals that benefit the organization.
- Evaluate staffing with work loads to ensure adequate coverage, making necessary decisions to add or decrease FTE's.
- Maintained productive work teams.
- Led cross-functional teams to achieve project milestones and deliver high-quality results.
- Established protocols for auto-approvals to increase compliance with turn around time standards.
- Compile data and prepared periodic reports.
- Communicate with and prepare appropriate responses to multiple health plans regarding any corrective findings timely.
- Act as subject matter expert for prior authorization.
Manager, Managed Care
Regal Medical Group
San Bernardino , CA
05.2019 - 05.2023
- Managed and motivated 10+ employees to be productive and engaged in work.
- Accomplished multiple tasks within established timeframes.
- Maximized performance by monitoring daily activities and mentoring team members.
- Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
- Responsible for deferred authorization maintenance tracking and follow up.
- Manage and complete special projects for executive leadership and medical directors.
- Assisted with monitoring of prior auth process to assure patient care standards are met by all prior authorization staff.
- Identify gaps in staff training and schedule ongoing training sessions for established staff to review processes.
- Work in collaboration with clinical coordinator team supervisors to assist with daily operations.
- Provided auditing oversight to inpatient clinical and non clinical teams for executive leadership.
Project Manager
Regal Medical Group
San Bernardino , CaClifornia
02.2018 - 05.2019
- Successfully managed multiple projects, in both prior auth and inpatient departments, simultaneously by prioritizing tasks according to urgency, resource availability, and alignment with organizational goals.
- Managed 5 or more target programs and lead key projects to support standardization and process improvement activities related to inpatient and prior auth departments.
- Identified plans and resources required to meet project goals and objectives by collecting and analyzing data to recognize high value opportunities.
- Monitored project performance to identify areas of improvement and make adjustments.
- Develops and coordinate strategies in collaboration with medical directors and vice president to to analyze UM protocols and identify trends to make recommendations to improve authorization management.
- Established feedback loops to measure and report the effectiveness or programs and intervention and implemented modifications/enhancements as appropriate.
- Interpret and analyze campus utilization and budget reports for medical directors.
Skills
- IPA functions
- Strategic planning
- Training, coaching & leadership development
- Operations management
- Health plan communication
- Resource allocation
- Process development & improvement
- Cross-functional collaboration & communication
- Data-driven decision making
- Data analytics utilizing Tableau
Timeline
Senior Manager, Prior Authorization
Regal Medical Group
05.2023 - Current
Manager, Managed Care
Regal Medical Group
05.2019 - 05.2023
Project Manager
Regal Medical Group
02.2018 - 05.2019