Renisha Diaz
Humana
North Port,USA
1
Certification
11
years of professional experience
A goal-oriented individual with the proven ability to lead and motivate and optimize healthcare value with the ability to navigate insurance criteria, prevent over-utilization, and streamline discharge planning. Seeking to bring strong analytical and communication skills to Humana’s organization.
Work History
Utilization Management Coordinator
2 Years 7 Months- Contributes to administration of utilization management with semi-routine assignments Attention to Detail and precision in documentation ensuring accurate claims processing and regulatory compliance.
- Review for Concurrent, Prior Authorization, SNF, LTAC and Rehab.
- Coordination of P2P discussion between attending physicians and Humana’s Medical Directors.
- Ensuring accuracy of case documentation and organizational state timelines.
- Outbound calls to providers to arrange P2P’s and to supply status updates.
- Documentation of case interactions, attach faxes/data into Members file.
- Collaborative support & partnership with internal nurses, Managers, and MD to streamline the continuity of care and authorization workflow.
- Verification of Members eligibility for authorization, processing, rebuilds and voids.
Care Management Support Assistant
1 Year 4 Months- Outbound calls Completing HRA’s with Members.
- Provide non-clinical support to the assessment and evaluation of members' needs.
- Guide members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members.
- Utilizing documents guides in Microsoft , Word, Excel, and Outlook.
- SME- Assisting with outreach for members with urgent needs.
LPN
6 Months- Assist physician and RNs in the care of patients by performing one or more of the following duties:
- Administering chemotherapy agents
- Assist physician and RNs in the care of patients by performing one or more of the following duties:
- Administering chemotherapy agents
- Port/ Picc Line Access and dressing changes
- Patient assessments/triage/ Nurse Evaluations
- Medical record documentation
- Patient/family education
LPN II
10 Months- Patient intake assessment Triage and Discharge
- Assist Physician with administering medications/injections
- Process Referral orders for patients
- EMR
- Port/ Picc Line Access and dressing changes
- Patient assessments/triage/ Nurse Evaluations
- Medical record documentation
- Patient/family education
Alternate Administrator
4 Years 2 Months- Responsible for recruiting, orientation, and informing contractors for state law and regulations
- Facilitate proper and lawful patient care with the physician
- Knowledge of all federal, state and local laws governing the practice overseen by the Agency for Healthcare Administration
- Safety liaison leading in an emergency response showing caregivers how to provide continuous care during emergency situations
- Report and constant communication with the Administrator
Education
Practical Nursing
Associate of Arts
Diploma
Skills
Leadership
Management
Policy and Procedure
Data analysis
Government regulations such as Medicare and Medicaid
EKG Machine
Regulatory & Payer Expertise
IV Removal
Ambulate Patients
Use of Hoyer Lifts
Foley Catheter Insertion and Removal
Head to Toe Assessment
Vitals
Peg Tube Care
Tube Feedings
Med Administration
Wound Care
Focus Assessments
Certification
- LPN Certification | License: PN 5246778
- IV Certification
- American Heart Association | BLS
Timeline
Utilization Management Coordinator
Humana
11.2023 - CurrentRead More
Care Management Support Assistant
Humana
07.2022 - 11.2023Read More
LPN
Florida Cancer Specialist
01.2022 - 07.2022Read More
LPN II
Community Specialty Clinic
02.2021 - 12.2021Read More
Alternate Administrator
Granny Nannies of Port Charlotte
05.2015 - 07.2019Read More
Port St. Lucie High School
Diploma
Read More
Edison State College
Associate of Arts
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Cape Coral Technical College
Practical Nursing
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