Svetlana Yankovskaya
New York,NY
Summary
Professional with strong background in case management, prepared to make significant impact. Proven ability to collaborate with teams and adapt to changing needs. Skilled in client assessment, resource coordination, and crisis intervention. Reliable and results-focused, with commitment to achieving positive outcomes.
Overview
19
19
years of professional experience
Work History
Utilization Review/Case Manager
MedRevew, INC
03.2018 - 12.2020
- Conducted comprehensive review of medical records to determine the appropriateness and necessity of healthcare services.
- Collaborated with healthcare providers to ensure compliance with established clinical guidelines and protocols.
- Evaluate patients treatment plans, including medications, procedures, and therapies to optimize quality of care while minimizing costs.
- Identified potential overutilization or underutilization of healthcare resources and recommended appropriate interventions.
- Utilized Milliman criteria and clinical expertise to make informed decisions regarding medical necessity and level of care.
- Conducted ongoing monitoring and evaluations of behaviors and conditions, and updated clinical supervisors with current information.
- Facilitated therapeutic communication, conflict resolution and crisis intervention.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
Case manager, RN
Archcare
11.2017 - 03.2018
- Interacted telephonically with network providers and members of HMO to manage mental health and substance abuse services for enrollees of Medicaid and Medicare.
- Managed a caseload of 120-180 clients providing comprehensive case management services.
- Conducted thorough assessment to determine clients need and develop individualized care plans.
- Collaborated with health care team to coordinate and monitor the delivery of services.
- Facilitated regular, monthly meetings with clients telephonically to review goals, identify barriers and monitor progress.
- Coordinated referrals for community agencies as needed.
- Provided crisis intervention and emotional support to clients in challenging situations.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
- Developed and implemented comprehensive case management plans to address client needs and goals.
- Improved client satisfaction by efficiently addressing concerns or grievances in a timely manner.
- Assisted clients in navigating housing, legal services and public benefits to gain access to valuable resources.
- Collaborated with multidisciplinary teams to address client needs and formulate tailored support strategies.
- Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
Field RN/Case manager
Archcare Inc.
01.2016 - 04.2017
- Visited members at home, SNF, hospitals and community settings.
- Conducted member’s physical assessments, evaluated member’s medical condition and home and surroundings for safety.
- Checked the doctor’s order for prescribed medications and expiration date. Called a physician and/or pharmacy as needed.
- Documented all relevant information, developed and monitored an individual care plan.
- Provided emotional support to patients coping with chronic illness or end-of-life decisions, fostering resilience during difficult times.
- Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
Behavioral Health Case Manager/Utilization Review Nurse
Health First Inc.
07.2001 - 09.2013
- Obtained telephonic initial and concurrent inpatient reviews on the members, recipients of Medicaid, Medicare, CHP, and private med insurance, who were admitted to the hospitals, or clinical psychiatric settings.
- Review all physician requests for medical necessity and appropriateness of the setting
- Document the medical necessity of review decisions, utilizing Health Plan appropriate criteria, if applicable.
- Work with the multiple Medical Directors in determining referral approvals or denials for cases that do not meet criteria.
- Obtained concurrent inpatient reviews on all patients admitted to the hospitals or psychiatric settings.
- Assessed for the length of stay, appropriateness for inpatient level of care and provide discharge planning ie: home health social work or nursing visits.
- Worked with the coordinator in processing referral requests and providing direction to complete task.
- Developed strong relationships with local service providers, fostering collaboration that benefited clients'' overall progress toward recovery goals.
- Connected patients to community resources, increasing support networks and promoting overall wellbeing.
Education
Bachelor of Science - Nursing
Hunter College
New York, NY07-1999
Master of Science - Psychology
National University, Kyiv, Ukraine
Kiev, Ukraine05-1989
Skills
- Problem-solving
- Case management
- Time management
- Case documentation
- Active listening
- Relationship building
- Critical thinking
- Client advocasy
Languages
Russian
Native or Bilingual
Ukrainian
Native or Bilingual
Timeline
Utilization Review/Case Manager
MedRevew, INC
03.2018 - 12.2020
Case manager, RN
Archcare
11.2017 - 03.2018
Field RN/Case manager
Archcare Inc.
01.2016 - 04.2017
Behavioral Health Case Manager/Utilization Review Nurse
Health First Inc.
07.2001 - 09.2013
Bachelor of Science - Nursing
Hunter College
Master of Science - Psychology
National University, Kyiv, Ukraine
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