Thea Arafiles
Chino Hills,CA
Summary
Motivated professional eager to embrace new challenges. Demonstrates a strong work ethic and adaptability, complemented by exceptional interpersonal skills. Proven ability to work independently and rapidly acquire new competencies.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse
KPC Global Management
Corona, CA
01.2021 - 09.2025
- Demonstrated knowledge of Center of Medicare and Medicaid Services and private payor regulations regarding inpatient hospitalization.
- Monitored pre-authorization requests to ensure that all necessary information was received prior to approval or denial of services.
- Analyzed medical record documentation to assess appropriateness and necessity of health care services.
- Applied evidence-based criteria utilizing Milliman and Interqual guidelines for evaluations.
- Assisted physicians in determining appropriate admission status and level of care for patients.
- Reviewed patient records to ensure quality of care and efficient resource utilization.
Care Coordinator/Case Manager
Aspire Healthcare Services
Upland, CA
07.2018 - 12.2020
- Collaborated with physicians, case managers, discharge planners, and social workers to manage home health service referrals.
- Managed scheduling of appointments and follow-up visits for patients.
- Communicated effectively with patients to address concerns and provide support.
Intake Coordinator/Case Manager
Quality Care Home Health Specialist
West Covina, CA
12.2015 - 06.2018
- Verified Medicare coverage to assess patient eligibility for admission, ensuring compliance with requirements.
- Scheduled appointments and managed calendars for healthcare professionals.
- Coordinated the intake process for new clients, including scheduling initial assessments and providing necessary paperwork.
Massage Therapist
Massage Envy
Anaheim Hills
09.2008 - 12.2015
- Provided therapeutic massage services to clients, addressing individual needs and preferences.
- Educated clients on self-care techniques and wellness practices for improved health.
- Ensured compliance with health and safety regulations to maintain a safe environment.
Licensed Vocational Nurse
Foothill Presbyterian Hospital
Glendora, CA
01.2002 - 07.2008
- Administered medications and treatments per healthcare provider prescriptions.
- Maintained accurate medical records to ensure compliance with regulations.
- Assisted in developing and executing patient care plans for improved outcomes.
- Collaborated with registered nurses to deliver comprehensive, high-quality patient care.
Education
Medical Billing & Coding -
UEI College
Anaheim, CA07.2015
Vocational Nursing -
Citrus College
Covina, CA12.2000
Skills
- Clinical expertise and documentation
- Analytical and critical thinking
- Pre-authorization processing
- Effective communication
- Time management skills
- Attention to detail
- Proficient in medical software
Certification
License, Vocational Nursing Date of Issuance: 11/01/2001
References
References available upon request.
Timeline
Utilization Review Nurse
KPC Global Management
01.2021 - 09.2025
Care Coordinator/Case Manager
Aspire Healthcare Services
07.2018 - 12.2020
Intake Coordinator/Case Manager
Quality Care Home Health Specialist
12.2015 - 06.2018
Massage Therapist
Massage Envy
09.2008 - 12.2015
Licensed Vocational Nurse
Foothill Presbyterian Hospital
01.2002 - 07.2008
Medical Billing & Coding -
UEI College
Vocational Nursing -
Citrus College