Tonia Brinson
Santa Rosa,CA
Summary
Dynamic healthcare professional with extensive experience at Azure Acres, excelling in utilization management and compliance. Proven ability to enhance patient care through effective communication and clinical assessment. Skilled in HIPAA compliance and quality improvement, fostering collaboration among multidisciplinary teams to streamline processes and improve operational efficiency.
Overview
16
16
years of professional experience
Work History
UM Concurrent Reviewer
Azure Acres
Sebastopol, CA
12.2017 - Current
- Assessed medical records to ensure compliance with utilization management standards.
- Evaluated care suitability using clinical guidelines.
- Partnered with healthcare professionals to obtain critical patient details.
- Collaborated in case conferences to review and recommend treatment approaches.
- Recorded review findings precisely in electronic health record systems.
- Facilitated patient care decisions through effective communication with multidisciplinary teams.
- Served as liaison between healthcare providers and insurance carriers to ensure effective communication.
- Ensured compliance by staying current with medical policies, regulations, and guidelines.
- Streamlined review processes, resulting in improved efficiency and timely decision-making for patient care.
- Contributed to case management meetings by presenting findings from concurrent reviews, fostering an environment of collaboration among colleagues from various disciplines within the organization.
- Conducted comprehensive chart audits to identify areas for documentation improvement and provided feedback to clinicians for continuous growth.
- Evaluated medical necessity documentation to support the appropriate level of care for patients.
- Identified trends in resource utilization, providing valuable insights for process improvement initiatives.
- Ensured accurate data entry into relevant systems while maintaining strict confidentiality in accordance with HIPAA guidelines.
- Evaluated treatment plans to ensure alignment with evidence-based practices during concurrent reviews.
- Enhanced patient care by conducting thorough concurrent reviews and ensuring appropriate utilization of resources.
- Responded promptly to inquiries from healthcare professionals regarding case updates or additional information needed for timely decision-making on patient care plans.
- Managed a high volume of cases efficiently, prioritizing tasks based on urgency and complexity.
- Developed strong relationships with healthcare providers through consistent collaboration and open communication channels during the review process.
- Mentored new hires, providing guidance and support to help them become effective concurrent reviewers.
- Utilized analytical skills to evaluate complex cases, ensuring accurate determinations were made based on medical necessity criteria and standards of care guidelines.
- Collaborated with interdisciplinary teams for optimal patient outcomes through effective communication and case management.
- Worked with healthcare team to develop new dialysis treatment flow sheet and other log forms, improving clinical documentation and accountability.
- Investigated and resolved issues affecting hospital operations and patient care.
- Sustained quality standards by performing routine medication audits and upholding internal and industry best practices.
- Participated in evidence-based practice project implementation, nursing competency development and nursing simulation activities.
- Recorded details regarding therapies to keep patient charts updated.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies.
- Evaluated patient histories, complaints, and current symptoms.
- Communicated with healthcare team members to plan, implement and enhance treatment strategies.
Intake Specialist/UM and Front Office Coordinator
Campobello
Santa Rosa, CA
05.2009 - 12.2016
- Evaluated client needs to enhance intake processes.
- Developed and maintained comprehensive documentation of client interactions and outcomes.
- Facilitated seamless client services through teamwork with multidisciplinary groups.
- Streamlined intake procedures to enhance operational efficiency.
Education
AOD Certificate - Alcohol And Other Drugs
Santa Rosa Junior College
Santa Rosa, CA06.2007
Skills
- HIPAA compliance
- Quality improvement
- Healthcare regulations
- Utilization review
- Clinical assessment
- Insurance verification
- Documentation and reporting
- Inpatient care
- Patient care plans
- Outpatient care
- Utilization management
- Needs assessment
- Physician consultations
- Communication
- Compliance procedures
- Performing assessments
- Patient transfers and transitions
- Teamwork
- Plan of care support
- Discharge planning
- Interpersonal and written communication
- Records analysis
- Discharge planning coordination
Timeline
UM Concurrent Reviewer
Azure Acres
12.2017 - Current
Intake Specialist/UM and Front Office Coordinator
Campobello
05.2009 - 12.2016
AOD Certificate - Alcohol And Other Drugs
Santa Rosa Junior College