Summary
Overview
Work History
Education
Skills
Accomplishments
Software
Work Availability
Timeline
Volunteer

Michele Phelps

Utilization Management Specialist / Case Management Assistant
Redlands,CA

Summary

Reliable individual bringing 18 years of experience in healthcare environments. Maintains positive relationships with case managers and providers. Remains polished and calm under extreme stress. Dependable Utilization Review specialist promoting over 18 years of expertise in healthcare industry. Knowledgeable in admissions and stay reviews. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level patient access director position. Ready to help team achieve company goals. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.

Overview

18
18
years of professional experience

Work History

Utilization Management Representative

REDLANDS COMMUNITY HOSPITAL
REDLANDS, California
05.2005 - Current
  • Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
  • Served as subject matter resource, providing information related to insurance verification and authorization situations.
  • Devise or identify solutions for irregular requests and issues.
  • Performed prior authorization review of services requiring notification.
  • Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
  • Performed admission reviews based for medical necessity based upon diagnosis specification.
  • Obtained authorizations from multiple insurance carriers for various levels of care.
  • Submitted cases for criteria failures and helped facilitate resolutions and approvals.

Education

No Degree - Registered Nursing

San Bernardino Valley College
San Bernardino, CA
05.2001 -

No Degree - Registered Nursing

College of The Desert
Palm Desert, CA
05.2001 -

Bachelor of Science - Business Management

Riverside City College
Riverside, CA
06.2023 - Current

Skills

Documentation and reporting

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Accomplishments

  • Achieved accolades by completing lean projects with accuracy and efficiency.
  • Collaborated with team of 20 in the development of extended recovery program.
  • Documented and resolved denials which led to positive revenue outcomes.
  • Achieved awards through effectively helping with streamlining and educating team with manufacturing user manuals for admitting team.

Software

Meditech

Microsoft

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline

Bachelor of Science - Business Management

Riverside City College
06.2023 - Current

Utilization Management Representative

REDLANDS COMMUNITY HOSPITAL
05.2005 - Current

No Degree - Registered Nursing

San Bernardino Valley College
05.2001 -

No Degree - Registered Nursing

College of The Desert
05.2001 -
Michele PhelpsUtilization Management Specialist / Case Management Assistant