Teiara Buford
Oklahoma City,OK
Summary
Insightful Utilization Review Specialist recognized for high productivity and efficient task completion. Skilled in thorough medical record evaluation, effective communication with healthcare providers, and adept at regulatory compliance. Excel in critical thinking, problem-solving, and adaptability to dynamic healthcare environments. Committed to optimizing patient care outcomes while ensuring adherence to healthcare policies and procedures.
Overview
3
3
years of professional experience
1
1
Certification
Work History
Lead Utilization Review Specialist
Prestige Utilization Management & Billing
Remote, OK
11.2022 - Current
- Performed retrospective reviews for post-acute services such as home health, skilled nursing facilities, long-term acute care hospitals, rehabilitation centers.
- Served as a liaison between payers, providers, patients and families concerning authorization decisions.
- Collaborated with physicians, nurses, case managers, discharge planners, social workers and other healthcare professionals to develop a comprehensive plan of care within specified guidelines.
- Participated in interdisciplinary team meetings to discuss complex cases or those requiring an alternative treatment plan or continued stay evaluation.
- Developed clinical pathways and protocols to ensure quality of care and utilization of resources.
- Interpreted coverage policies and benefit provisions as they relate to the clinical setting.
- Maintained accurate documentation related to all activities performed in compliance with departmental policies.
- Provided education and guidance on utilization management principles to internal staff members.
- Monitored trends in utilization patterns and made recommendations for improvement as needed.
- Attended relevant meetings and conferences related to Utilization Review activities.
- Adhered to all federal, state and local laws governing healthcare operations.
- Analyzed treatment plans for appropriateness, effectiveness and medical necessity in accordance with established criteria.
- Provided consultation on appropriate use of services to staff members including utilization management strategies.
- Assessed patient's health needs and identified potential risk areas through review of records and interviews with providers.
- Conducted concurrent reviews to monitor the ongoing appropriateness of services provided to members.
- Worked with insurance companies and patients to determine best courses of action.
Care Management Support Coordinator
Centene, Superior Health Services
Oklahoma City, OK
02.2024 - 08.2024
- Ensured compliance with all applicable federal, state, local laws and regulations governing human services delivery systems.
- Completed assessments of client needs and preferences.
- Provided crisis intervention services, as needed.
- Acted as an advocate on behalf of clients when appropriate and necessary.
- Assessed risk factors associated with a variety of mental health issues and developed strategies for managing them effectively.
- Managed caseloads consisting of up to 20-25 individuals at any given time.
- Developed and maintained relationships with external service providers.
- Participated in staff meetings, trainings, and conferences. Related to job duties and expectations.
- Evaluated customer feedback surveys regularly to identify areas where improvements could be made.
- Provided education about available community resources such as housing, employment opportunities, financial assistance programs.
- Monitored progress of clients' goals and objectives.
Discharge Planner
Oakwood Springs Hospital
Oklahoma City, OK
11.2022 - 09.2023
- Educated families on available resources in order to help them better understand their loved one's diagnosis and treatment plan before being discharged from the hospital.
- Participated in multidisciplinary team meetings when determining appropriate levels of care prior to discharge.
- Coordinated community resources such as housing, food banks, financial assistance programs. for discharged patients who need additional support after leaving the hospital.
- Developed individualized discharge plans for hospitalized individuals according to their physical and mental health needs.
- Provided follow up phone calls and home visits post-discharge in order to monitor progress of discharged patients.
- Provided education, support, and guidance to families of discharged patients.
- Assisted in the coordination of services needed after hospitalization such as home health care, durable medical equipment, transportation.
- Identified any potential barriers or risks that may impede successful outcomes post-discharge.
- Collaborated with other healthcare professionals to ensure successful transition from hospital to home setting.
- Performed crisis intervention when necessary by providing emotional support to discharged patients and family members.
- Created a safe environment for discharged patients by providing information about safety precautions at home and in the community.
- Facilitated referrals for follow up appointments with specialists or primary care providers post-discharge.
Outpatient Registered Behavior Technician
Jdmcapitalcorp
Oklahoma City, OK
11.2021 - 10.2022
- Tracked data and monitored progress of student's goals and objectives.
- Provided direct one-on-one instruction to children with autism in a variety of settings.
- Demonstrated excellent organizational skills while managing multiple tasks simultaneously.
- Instructed staff members on how to implement behavioral interventions and utilize positive reinforcement strategies effectively.
- Implemented visual supports such as schedules, picture cards.
- Utilized Applied Behavioral Analysis principles in daily instruction activities.
- Assisted in the development of positive behavior supports within the classroom environment.
- Assisted in developing home programs that support generalization across settings.
- Developed and implemented behavior intervention plans based on individualized needs.
Education
Behavioral Sciences
Grand Canyon University
Phoenix, AZ03-2026
Diploma
San Pedro Senior High School
San Pedro, CA06-2014
Skills
- Healthcare regulations
- Utilization Management
- HIPAA Compliance
- Medicare Compliance
- Quality Improvement
- Patient Care Plans
- Utilization review
- Discharge Planning
- Interpersonal and written communication
Affiliations
- Plant mom - Indoor plants and I love Pathos!
- Kayaking
- Hiking
- Yoga
- Meditation
Certification
- Deans List 2022 - present
- National Society of Collegiate Scholars
- Honor Roll
Languages
English
Full Professional
References
References available upon request.
Timeline
Care Management Support Coordinator
Centene, Superior Health Services
02.2024 - 08.2024
Lead Utilization Review Specialist
Prestige Utilization Management & Billing
11.2022 - Current
Discharge Planner
Oakwood Springs Hospital
11.2022 - 09.2023
Outpatient Registered Behavior Technician
Jdmcapitalcorp
11.2021 - 10.2022
Behavioral Sciences
Grand Canyon University
Diploma
San Pedro Senior High School
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