

Experienced with conducting thorough utilization reviews to ensure effective resource use and patient care. Utilizes clinical judgment to assess and recommend appropriate treatment plans. Track record of ensuring compliance with healthcare regulations and improving patient outcomes.
• Accurately and thoroughly document patient clinical information given by medical office staff
• Review clinical information to determine the appropriate imaging pathway for superior and effective patient care
• Provide comprehensive medical management utilizing industry standard care guidelines and treatment protocols
• Evaluate the necessity, quality, effectiveness or efficiency of medical services, procedures, and facilities
• Conducts hospital wide quality assurance issues and provide customer relations regarding plan benefits
• Perform utilization, concurrent, retrospective reviews, and discharge planning communicated directly with physician providers/designees
• Responsible for rendering nursing care to patients in the wards. (OB-Gyne, Pediatrics, Internal Medicine, Surgery )
• Utilizes assessment skills and techniques to determine patient’s needs on admission through clinical observation and physical assessment
o Conducts interviews and interacts with the patient and their significant others.