Myra Marshall-Mixco

Serve as Certified InterQual Trainer, educating clinical staff on criteria application and documentation standards

• Provide structured feedback and real-time coaching to clinical staff to improve documentation quality and adherence to care management protocols
• Conducted quality audits of 30+ UM audits for inpatient, outpatient, and post-acute cases, ensuring adherence to Interqual Quality and NCQA standards
• Conduct quality audits of 20+ CM audits. evaluating call quality, clinical documentation, and adherence to NCQA standards
• Reviewed and analyzed care management workflows, identifying documentation gaps and regulatory risks to enhance compliance
• Support quality improvement initiatives aimed at improving audit outcomes and member satisfaction
• Analyze audit data and generate performance reports to support leadership decision-making
• Participate in accreditation readiness activities and regulatory audit preparation
• Complete and monitor member survey processes to ensure compliance with quality standards

• Completed 15-20 concurrent and initial post-acute reviews daily using InterQual and Orinoco EMR.
• Ensured medical necessity determinations and documentation accuracy to enhance quality and authorization outcomes.
• Collaborated with medical directors and interdisciplinary teams to ensure timely, compliant reviews.
• Partnered with healthcare providers to optimize resource utilization and improve patient care.
• Monitored compliance with regulatory standards and guidelines in utilization management.
• Performed utilization reviews, concurrent reviews, authorization requests, and discharge planning to facilitate efficient patient transitions.

• Audited 20+ clinical interactions daily to assess quality standards, documentation accuracy, and regulatory compliance.
• Identified quality trends, contributing to performance improvement initiatives through structured feedback that informed action plans.
• Evaluated training effectiveness through participant assessments and feedback, enhancing future training programs.
• Created educational materials that facilitated ongoing professional development and improved nursing practice.

• Coordinated patient transitions between care settings to ensure effective recovery.
• Educated patients and families on post-discharge resources and services to empower self-management.
• Facilitated communication between healthcare providers and patients during transitions.
• Conducted assessments to identify patient needs and potential barriers to care.
• Monitored patient progress through follow-up calls, home visits, and clinic appointments to address needs promptly.

• Trained new staff on compliance policies and procedures, ensuring adherence to regulations.
• Trained new employees on company policies and procedures.
• Conducted performance evaluations, delivering constructive feedback to support employee development.
• Facilitated team meetings to discuss project updates and challenges.
• Directed and supervised team of 15 employees, overseeing daily operations to achieve team objectives.

• Led multidisciplinary clinical teams supporting Medicaid, behavioral health, NICU, and home health populations.
• Oversaw QAPI programs and documentation audits to enhance quality improvement initiatives.
• Applied Lean and Six Sigma training to streamline workflows, reduce errors, and improve quality outcomes.
• Trained staff on protocols and procedures, ensuring adherence to optimal workflow standards.
• Supervised daily operations, facilitating effective patient care delivery.