Prior Authorization and Utilization Management
Suzanne Gariss
Plant City,FL
Summary
Highly proficient and organized Nursing professional with over 14 years of experience in utilization management, discharge planning, and leadership skills
Overview
14
14
18
18
Nursing Professional
15
15
years of professional experience
Work History
Supervisor, Medical Management
Centene Corporation
02.2022 - 10.2023
- Managed prior authorization third-party program relationships with vendor partners for performance management, financial responsibility, and proactively implemented appropriate business solutions
- Directed, monitored, and contributed to special projects, and other highly complex initiatives involving oversight of vendors
- Maintained regular communications with leads at vendors and worked internally to communicate plan and business partner needs to vendors
- Handled provider and vendor complaints, resolved issues, and adjusted policies to meet changing needs
Concurrent Review Nurse II
Centene Corporation
09.2019 - 02.2022
- Delivered onsite and faxed medical necessity reviews of inpatient and observation admissions for Medicaid and Marketplace plans to assigned hospitals
- Facilitated discharge planning from acute care setting to appropriate level of care upon discharge
- Managed daily team census and TAT reports
- Trained and mentored new hires
Concurrent Review I
Centene Corporation
04.2014 - 09.2019
- Delivered onsite and faxed medical necessity reviews of inpatient and observation admissions for Medicaid, Medicare Advantage, and Marketplace plans to assigned hospitals
- Facilitated discharge planning from acute care setting to appropriate level of care upon discharge
- Trained and mentored new hires
Clinical Reviewer
Care Centrix
05.2013 - 03.2014
- Handled faxed and telephonic medical necessity reviews of outpatient and home health services for multi-state Commercial plans in high volume call center
Field Nurse Liaison
Humana
09.2010 - 03.2012
- Performed onsite medical necessity reviews of inpatient and observation admissions for Medicare Advantage and Commercial plans to assigned high volume level 2 trauma hospital
Care Coordinator, Prior Authorization
Amerigroup
12.2008 - 09.2010
- Conducted faxed and telephonic medical necessity reviews of emergent and elective inpatient admissions and outpatient services for multi-state Medicaid plans in high volume call center
Education
Bachelor of Arts - Management, Concentration in Human Resources
American Public University
Charles Town, WV2025
Diploma - Practical Nursing
Erwin Technical Center
Tampa, FLSkills
- Utilization Management
- InterQual criteria
- Medicaid / Medicare / Marketplace
- Prior Authorization
- Vendor Relations
- Leadership
Timeline
Supervisor, Medical Management
Centene Corporation
02.2022 - 10.2023
Concurrent Review Nurse II
Centene Corporation
09.2019 - 02.2022
Concurrent Review I
Centene Corporation
04.2014 - 09.2019
Clinical Reviewer
Care Centrix
05.2013 - 03.2014
Field Nurse Liaison
Humana
09.2010 - 03.2012
Care Coordinator, Prior Authorization
Amerigroup
12.2008 - 09.2010
Bachelor of Arts - Management, Concentration in Human Resources
American Public University
Diploma - Practical Nursing
Erwin Technical Center
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