SARAH JENSEN
Vernon,VT
Summary
Results-driven Utilization Review Coordinator known for high productivity and efficiency in task completion. Possess specialized skills in medical necessity criteria, regulatory compliance, and case management processes. Excel in critical thinking, communication, and decision-making, ensuring successful patient care coordination and healthcare service delivery optimization.
Overview
17
17
years of professional experience
Work History
Utilization Review Coordinator
Sun Medical
09.2018 - 07.2024
- Provide professional and thorough communication with external representatives to obtain authorization for admission and continued stay
- Interact with patient care staff to assure patient assessment and treatment plan is accurately and consistently reflected in facility documentation
- ASAM and DSM-5
- Assessed the appropriateness of length of stay for inpatient and outpatient admissions.
- Analyzed medical records to ensure compliance with regulatory requirements.
- Communicate authorization status, issues or problems to appropriate staff/departments
- Conducted utilization review activities including concurrent reviews, retrospective reviews, and discharge planning.
- Prioritize multiple and various types of case activity; coordinate with UM team to ensure all deadlines are met with highest possible quality of delivery
- Participated in meetings with health plan representatives regarding utilization management policies.
ADMISSIONS COORDINATOR
BRATTLEBORO RETREAT
10.2007 - 06.2019
- Performed a wide range of data collection and assisted in all phases of scheduling, pre- registration and registration process
- Evaluated referrals and walk-in admissions for appropriate level of care
- Scheduled clients for intake and ongoing services for all levels of care
- Performed insurance eligibility verification
- Communicated with patient's insurance providers to notify of admission and obtain preauthorization when needed
- Recorded all communication into the Electronic Health Record
- Served as a liaison with patient financial services
- Maintained communication with client regarding financial responsibility
- Performed administrative duties that include, but are not limited to, faxing, filing, answering phone calls, emailing, registration of patients, and scheduling appointments
- Maintained compliance with HIPPA
SUBSTANCE ABUSE COUNSELOR
HABIT OPCO
06.2015 - 08.2018
- Conducted individual and group addiction counseling sessions
- Responded to requests from outside organizations for coordination of care in a timely manner
- Developed treatment plans focused on patient's identified goals
- Provided direct care and services to patients through assessment, educational and therapeutic groups, individual counseling, case management, treatment planning, and continuing care planning
- Collaborated with treatment team members to assist patients in their recovery, including MD, RN, and other clinicians
Skills
- Well organized, with a strong ability to multitask Adaptable and flexible
- Exceptional interpersonal and communication skills
- Excellent customer service skills, with a friendly and outgoing personality
- Experience working remotely
- Extensive knowledge of substance abuse and mental health services
- Familiarity with medical terminology
- Experience with healthcare and insurance benefits, including Medicaid and Medicare
- Experience with nonprofit organizations
- HIPAA Compliance
- Utilization Management
- Interdisciplinary Collaboration
- Healthcare regulations
- Insurance Verification
- Records analysis
References
References available upon request.
Timeline
Utilization Review Coordinator
Sun Medical
09.2018 - 07.2024
SUBSTANCE ABUSE COUNSELOR
HABIT OPCO
06.2015 - 08.2018
ADMISSIONS COORDINATOR
BRATTLEBORO RETREAT
10.2007 - 06.2019
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