Nisha Pagán

• Determine medical eligibility, manage denials and authorizations
• Process DME and PT & OT service requests
• Identify covered services that are required to meet the goals and treatment plan for patients that receive Medi-Cal funding.
• Review eligibility for inpatient rehabilitation services
• Consult with other agencies and participate in specialty clinics
• Make data driven decisions to optimize referrals.
• Present and educate the community and stakeholders of our program’s value and state wide criteria.
• Provide mentorship and training to existing and new staff
• Current project includes Transition to Adulthood with a focus on promoting mental wellness and the Multimedia Marketing state-wide group.

• Lead the execution and operations of durable medical equipment clinics across Orange County with third party vendors.

• Managed day-to-day business operations
• Enhanced operational efficiency and productivity by managing budgets, accounts, and costs.
• Managed and monitored insurance claim processing time and claim denial rate, resulting in a 10% improvement in operating cash flow
• Utilized data analysis and visualization tools such as Tableau and SPSS to create reports and dashboards for management, providing insights and recommendations for business decisions
• Built and maintained business relationships and contracts with non-profit organizations, vendors, and multiple insurance providers including Kaiser Permanente
• Manage resolution of customer issues
• Consulted with customers to assess needs and propose optimal solutions.
• Implement training and career development opportunities for the team.
• Trained and motivated employees to perform daily business functions.
• Evaluated suppliers to maintain cost controls and improve operations.

• Within inpatient acute rehabilitation setting, treatment and evaluations for pediatrics and geriatrics with cardiopulmonary disorders
• Within Seating Center addressed all manual and power equipment needs.

Inpatient rehabilitation hospital, school and outpatient setting with concentration in Infant and Toddler and Post Neonatal/Post-Pediatric Intensive Care Unit for medically fragile infants

• Assisted in spina bifida clinic, spasticity and orthotic clinics
• Monitored equipment needs for school aged and children in Adolescent Unit status post orthopedic surgery, TBI, SCI