ROSA RODRIGUEZ
Regal/Lakeside Community Healthcare Medical Group
San Fernando,California
1
Language
19
years of professional experience
Experienced healthcare professional with a background in case management, utilization management, authorizations, and care coordination. Skilled in coordinating services and managing high-volume workflows with accuracy, efficiency, and professionalism.
Work History
Out Patient Care Coordinator
13 Years 10 Months- Managed triage referrals, including opening, updating, and closing cases as appropriate.
- Monitored case management queues, managed assigned caseloads and provided administrative support to Case Managers.
- Conducted member outreach for enrollment in case management programs and provided post-discharge follow-up to support care transitions.
- Verified completion of discharge plan orders, including home health, DME deliveries, and follow-up appointments.
- Scheduled member appointments with providers and coordinated transportation services.
- Verified member eligibility and benefits with health plans.
- Retrieved medical records, and other clinical documentation from providers.
- Generated authorizations and accurately entered CPT, HCPCS, and ICD-10 codes.
- Maintained tracking logs to support timely case processing.
- Organized discharge census reports for Case Manager review and assignment.
- Supported Inpatient, Medi-Cal, SNP and Renal teams and assisted with special projects as needed.
Utilization Management & Compliance Coordinator
3 Years 4 Months- Input and process referrals.
- Assist with health plan audits and compliance-related activities.
- Request medical records from providers and hospitals.
- Assist with CCS authorization (SAR) processes.
Education
Associate's Degree - General Studies
Certification - Medical Assistant
High School Diploma
Skills
Critical thinking skills
Organizational skills
Customer service
Attention to detail
Verbal and written communication
Medical terminology
LANGUAGE
Spanish
Timeline
Out Patient Care Coordinator
Regal/Lakeside Community Healthcare Medical Group
11.2012 - CurrentRead More
Utilization Management & Compliance Coordinator
Preferred IPA
10.2007 - 02.2011Read More
San Fernando Senior High School
High School Diploma
Read More
Modern Technology College
Certification from Medical Assistant
Read More
Los Angeles Mission College
Associate's Degree from General Studies
Read More