Sandy Same
Miami,Fl.
Summary
To obtain a challenging and rewarding position in the medical/ healthcare industry where technical skills, education, experience, and commitment to professionalism will benefit my employer. Detail oriented with strong interpersonal skills and accountability. Proven success in relationship building and mentoring. Team player with excellent work ethics.
Overview
29
29
years of professional experience
Work History
Clinical Liaison
ScionHealth Kindred Hospital
Coral Gables, FL
12.2024 - Current
- Provide guidance and support to healthcare providers on the use of available resources.
Community Patient Assessment Coordinator
Kindred Healthcare
01.2021 - Current
- Responsible for all aspects of key account management within various hospital systems ensuring seamless and proper management of patient care prior to discharge to long term acute care
- Daily responsibilities include pre-assessment
- Ensure proper documentation and authorization on patient’s transfer as necessary
- Maintain relationships with hospital referral source resulting in census development
- Assist with coverage for all the clinical liaisons on the team
- Assist with downstream discharge planning by locating different resources available in the community.
Authorization and Appeals Nurse
Kindred
01.2017 - 01.2021
- Healthcare/Clinical Appropriateness Management, Responsibilities include combining strong relationship skills and clinical knowledge to manage the authorization and appeals process
- Responsible for processing appeal requests and authorizations
- Ensure all members have LTAC Criteria according to InterQual and MGM guidelines
- Coordinates the managed care determination and distributes information to the marketing and admissions support staff across multiple markets.
- Review patient medical records to determine if requested services are medically necessary and appropriate for the diagnosis.
- Maintained accurate documentation of all prior authorization activities in accordance with established policies and procedures.
- Provided guidance and support to staff members on prior authorization processes.
- Prepared detailed reports related to utilization management activities such as pre-authorization reviews, appeals, denials.
- Assessed the appropriateness of requesting provider's treatment plans based on clinical review criteria set forth by the payer or regulatory bodies.
Transitional Care Nurse Coordinator
All Dade Home Care
01.2016 - 01.2017
- Coordinate patient care with various medical needs, IV therapy, physical therapy, DME, HHA, skilled nursing
- Complete documentation on transfer, recertification, and discharge Oasis to ensure Medicare/ Medicaid compliance
- Serve as a liaison in the community to provide support for providers, clinical staff, and patients
- Work closely with providers to ensure excellent patient navigation.
Field Case Manager
UHC Preferred Care Partners
01.2006 - 01.2012
- Responsible for the assessing, planning implementation, coordination, monitoring, and evaluation of health-related services in the HMO environment
- Ensure patients are discharged to the appropriate setting, assist with discharge planning and scheduling follow up appointments
- Evaluate all admissions based on InterQual and MGM guidelines daily
- Report all High-Risk patients to in house case managers for follow up and education.
- Conducted in-depth assessments of patients' needs and developed individualized care plans.
- Collaborated with medical personnel to coordinate services for clients.
- Facilitated referrals to community resources such as housing, food banks, employment assistance programs.
- Maintained accurate records of client interactions and documentation of services provided.
LPN/ ER Case Manager
Hialeah Hospital
01.2001 - 01.2006
- Responsible for assisting in treatment for trauma, medical, pediatric and geriatric population
- Assessment, intervention, education and discharge
- Case
- Manager, responsible for all documentation on transfers, admission, and discharges
- Input clinical information into InterQual to ensure appropriate criteria for all admissions.
Outpatient Admissions Supervisor
Baptist Outpatient Center
Miami, FL
09.1996 - 09.2000
- Provided technical support to users on various software applications.
- Conducted user training sessions for new and existing staff members.
- Developed and maintained corporate policies and procedures related to IT systems usage.
- Trained new customer service representatives on company policies and procedures.
- Conducted regular staff meetings to review performance goals and objectives.
- Evaluated individual employee performance through one-on-one coaching sessions.
- Researched escalated customer complaints and worked with other departments to resolve issues quickly and efficiently.
- Developed training materials for new hires related to customer service best practices.
- Identified potential problems that could impact the delivery of services or products, and recommended solutions to management team members.
- Assisted in developing methods for measuring customer satisfaction levels.
Education
Associate of Science - Registered Nurse
Excelsior College ASN
Albany, NY01.2020
Miami Dade Community College
01.2012
LPN Diploma -
Robert Morgan Education Center
01.1999
Skills
- Maintain ongoing competency with nursing regulatory, HIPPA, Isolation and
- Infection control, hospital policy and procedures
- Efficient in
- Microsoft Office (Word, Excel, Power Point, Access, and Outlook)
- Transition of Care, Referral platforms- Allscripts, Navi health, Ensocare
- Hedis, CMS regulatory requirements for accreditations, MCG Milliman clinical
- Guidelines, InterQual
- Training Initiatives
- Materials Organization
- New Hire Training
Languages
Timeline
Clinical Liaison
ScionHealth Kindred Hospital
12.2024 - Current
Community Patient Assessment Coordinator
Kindred Healthcare
01.2021 - Current
Authorization and Appeals Nurse
Kindred
01.2017 - 01.2021
Transitional Care Nurse Coordinator
All Dade Home Care
01.2016 - 01.2017
Field Case Manager
UHC Preferred Care Partners
01.2006 - 01.2012
LPN/ ER Case Manager
Hialeah Hospital
01.2001 - 01.2006
Outpatient Admissions Supervisor
Baptist Outpatient Center
09.1996 - 09.2000
Associate of Science - Registered Nurse
Excelsior College ASN
Miami Dade Community College
LPN Diploma -
Robert Morgan Education Center