Suzanne Suppers

• Provided emotional support and counseling to patients and their families.
• Participated in multidisciplinary team meetings to discuss patient care plans.
• Performed triage assessments of walk-in patients in a clinic setting.

* Supervised UM nurses for appropriate level of care from medical record, obtained inpatient authorization, management of denials .

* Knowledge of Interqual/ MCG criteria

• Coordinated discharge planning activities including arranging follow up appointments or referrals for additional services.
• Collaborated with doctors to plan post-treatment home care and prevent return hospitalization.
• Utilized critical thinking skills to assess clinical situations quickly and accurately.
• Demonstrated ability to work independently as well as collaboratively within a team environment.
• Coordinated discharge planning to ensure continuity of care post-hospitalization.
• Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
• Ensured compliance with regulatory agencies such as The Joint Commission and Centers for Medicare and Medicaid Services.
• Ensured compliance with standards of professional practice as well as state and federal regulations related to health care delivery services.
• Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
• Coordinated with healthcare team to establish, enact and evaluate patient care plans.
• Demonstrated strong problem-solving skills, resolving issues efficiently and effectively.

• Represented organizations in relations with governmental and media institutions.
• Reviewed medical records for accuracy, completeness and appropriateness of documentation related to case management services.
• Monitored and evaluated performance metrics to identify areas for improvement in case management services.
• Prepared and maintained budgets, personnel records or training manuals.
• Determined organizational policies regarding program eligibility, requirements and benefits.
• Consulted with staff on resolution of complex service issues.
• Developed benchmarks for measuring and monitoring strategic changes and organizational goals.
• Developed and implemented a comprehensive case management program to ensure the delivery of quality care.

* Responsibility for reducing readmissions

* Oversight of hospital based UM staff

• Updated and maintained discharge plan of care with physician, members of healthcare team, patients and families.
• Interpreted and evaluated diagnostic tests to identify and assess patient's condition.
• Developed relationships with patients to ensure they received the highest quality of care.
• Conducted evaluations to address changes in patient needs, conditions, and medications.
• Assessed and reviewed patients for discharge and planning and integrated services for patients requiring home care, home infusion and durable medical equipment (DME).
• Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.
• Arranged placement of new patient admissions and transfers according to clinical standards and guidelines.
• Collaborated with physicians on patient medications, medical needs and performance.
• Coordinated discharge planning to ensure continuity of care post-hospitalization.
• Facilitated referrals for specialized services such as physical therapy or hospice care when needed.
• Participated in team meetings to discuss treatment options for complex cases.
• Coordinated home care, home infusion, and durable medical equipment reducing patient wait times.
• Utilized critical thinking skills when assessing new information or changes in a patient's condition.
• Coordinated discharge planning with multidisciplinary teams ensuring safe transitions back into the community.
• Determined and coordinated appropriate level of care to meet individual patient needs.
• Collaborated with physicians during medical rounds, updated treatment plans and provided plan of care to patients and families.

• Identified opportunities for improvement within the utilization review process through data analysis.
• Coordinated with healthcare teams to develop care plans that meet patient needs and insurance coverage.
• Communicated with external partners such as managed care organizations or vendors on a regular basis.
• Conducted comprehensive reviews of patient records to ensure medical necessity and compliance with healthcare standards.
• Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
• Utilized evidence-based guidelines to support utilization review decisions and recommendations.
• Referred cases to secondary review for failure to meet criteria.
• Monitored pre-authorization requests to ensure that all necessary information was received prior to approval or denial of services.
• Conducted reviews of inpatient utilization for compliance with admission criteria and concurrent review requirements.

• Provided emotional support and counseling to patients and their families.
• Participated in multidisciplinary team meetings to discuss patient care plans.
• Performed triage assessments of walk-in patients in a clinic setting.
• Utilized critical thinking skills to assess clinical situations quickly and accurately.
• Adhered to infection control procedures to facilitate safe, clean patient environment.
• Conducted specified laboratory tests to help detect conditions and determine diagnosis.
• Provided emotional support and comfort to families during difficult times.
• Collected lab specimens, ordering and interpreting diagnostic tests and lab results.
• Assisted physicians during examinations or surgical procedures.