Yolanda Garcia
Downey,CA
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Smart Utilization Review Nurse considered critical thinker and problem-solver due to dynamic patient care planning and understanding of Medicare guidelines. Known for having great rapport with providers and insurance carriers.
Overview
7
7
years of professional experience
Work History
UM Reviewer
Network Medical Management
10.2021 - Current
- Performed prior authorization review of services requiring notification.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Evaluated patient histories, complaints, and current symptoms
Care Coordinator, Case Management
CareMore
07.2016 - 09.2020
- Used company software and databases to maintain records of services performed and patient conditions.
- Monitored, tracked, and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery.
- Built strong relationships with clients to deliver emotional support and companionship.
- Supported patient care excellence via planning and interpretation of programs.
- Performed prior authorization review of services requiring notification.
- Evaluated patient histories, complaints, and current symptoms.
Education
Vocational Nursing
American Career College
Anaheim, CA04.2020
Skills
- Determine Medical Necessity
- CPT Coding
- Authorization Management
- HIPAA Regulations
- Accurate Documentation
- Decision Making
- Attention to Detail
- Critical Thinking
- Direct Patient Care
- Care Coordination
Languages
Spanish
Full Professional
Timeline
UM Reviewer
Network Medical Management
10.2021 - Current
Care Coordinator, Case Management
CareMore
07.2016 - 09.2020
Vocational Nursing
American Career College
Similar Profiles
Quang ChuQuang Chu
Nurse Case Manager at Network Medical ManagementNurse Case Manager at Network Medical Management
Victor Garcia JrVictor Garcia Jr
Provider Grid Ops Senior Specialist at Network Medical ManagementProvider Grid Ops Senior Specialist at Network Medical Management
Brandi GamboaBrandi Gamboa
Medical Staff Coordinator at White Memorial Medical CenterMedical Staff Coordinator at White Memorial Medical Center