Italee Haye

Results-driven healthcare professional with comprehensive expertise in clinical rehabilitation, utilization management, and home health care coordination. Demonstrates advanced ability to evaluate medical necessity, apply InterQual and MCG criteria, and ensure compliance with Medicare and regulatory requirements. Proven track record of improving authorization efficiency, enhancing interdisciplinary collaboration, and supporting patient-centered outcomes across the continuum of care.

Recognized for strong analytical skills, process improvement, and mentorship of team members. Technologically proficient with industry tools.

Clinical Review Coordinator | Utilization management Ops - Optum - Remote

(2025-04)

• Conduct Pre service review for inpatient Rehab facility (IRF) in compliance with CMS guidelines.
• Analyze and investigate complex issues, identifying root causes and delivering actionable solutions
• Interpret data and apply subject matter expertise to resolve a wide range of operational challenges
• Manage non-standard requests and escalate or collaborate as needed to ensure resolution
• Maintain deep specialization in designated knowledge areas to support consistent, accurate outcomes
• Prioritize workload effectively to meet deadlines and performance targets in a fast-paced environment
• Communicate complex concepts clearly to stakeholders, translating theory into practical applications
• Provide coaching, feedback, and guidance to team members to enhance performance and skill development
• Serve as a subject matter expert and resource for less experienced staff

Clinical Review Coordinator | Home and Community Care - Optum - Remote

(2023-06 - 2025-03)

Conduct utilization review for home health services (SN, PT, OT, ST, MSW, HHA) in compliance with Medicare Chapter 7 guidelines. Maintain clear and professional communication with providers and management.

• Supported utilization review, care coordination, and regulatory compliance for home and community-based programs, serving as a liaison across stakeholders to ensure delivery of medically necessary services
• Managed end-to-end case review processes for home health services, averaging 12–14 cases daily while analyzing high-volume clinical documentation for Medicare compliance
• Collaborated with providers, case managers, and interdisciplinary teams to determine medical appropriateness and optimize patient outcomes
• Delivered provider education on pre-service authorization processes, reducing incomplete submissions and improving workflow efficiency and compliance
• Prepared comprehensive patient summaries and documentation to support coordinated, patient-centered care across interdisciplinary teams

Preservice coordinator | Care Coordinator - Optum - Remote

(2015-10 - 2023-05)

Preservice review (Clinical review for elective surgeries of appendicular skeleton and spine, inpatient care management and post-acute care management. Utilization management for outpatient care (PT, OT, ST)

• Led pre-service utilization reviews for elective surgeries, ensuring medical necessity, insurance coverage, and streamlined authorization processes through collaboration with physicians and case managers
• Analyzed clinical documentation to determine appropriateness of inpatient rehabilitation services (Acute Rehab, LTAC, SNF) for skilled therapies (PT, OT, SLP) using InterQual and MCG criteria
• Conducted quality assurance audits to identify performance gaps, improve compliance with clinical guidelines, and implement targeted training initiatives
• Initiated peer review referrals for cases not meeting established criteria, ensuring adherence to evidence-based standards and organizational policies
• Ensured regulatory compliance and minimized risk by meeting submission timelines and coordinating with contract teams to prevent delays, denials, and service disruptions

Occupational Therapist - Various Employers

(2009-10 - 2020-05)

Experience in Level 1 trauma inpatient and outpatient rehabilitation services at Bellevue Hospital Center; Mercy Medical Center, Skilled Nursing Facilities and home care focusing on acute and subacute rehab for patients with traumatic brain injuries, neurological conditions, and upper extremity injuries.

• Conducted comprehensive patient evaluations and designed custom upper extremity orthotics, collaborating with interdisciplinary teams to improve functional outcomes across all phases of care
• Assessed and implemented assistive technologies and adaptive devices, providing training to patients and caregivers to promote independence and ensure proper integration into care plans
• Partnered with multidisciplinary teams to develop and execute individualized therapy plans, enhancing patient independence through adaptive techniques and rehabilitative interventions
• Mentored new graduate hires through structured onboarding, including shadowing, competency assessments, documentation review, and policy adherence, ensuring successful transition into clinical roles

Master of Science - Occupational Therapy - York College

Bachelor of Science - Occupational Therapy - York College

Associate of Science - Occupational Therapy Assistant - LaGuardia Community College