Somalia Jordan

Assign and prioritize clinical cases for team member review based upon clinical urgency and turnaround times. Act as a clinical resource for unlicensed Utilization Review Care Coordinators and staff to provide clinical expertise, clarify referral source directives and requests regarding clinical questions and issues. Make on-going authorization decisions for health plans for which CareCentrix manages the reauthorization responsibilities.

Lead Care coordinator UMA - Carecentrix

(2018-01)

• Assign and prioritize clinical cases for team member review based upon clinical urgency and turnaround times.
• Act as a clinical resource for unlicensed Utilization Review Care Coordinators and staff to provide clinical expertise, clarify referral source directives and requests regarding clinical questions and issues.
• Make on-going authorization decisions for health plans for which CareCentrix manages the reauthorization responsibilities.
• Issue service reauthorizations for the home care provider based on medical necessity and payer benefit guidelines.
• Participate in and contribute to ongoing utilization management activities, quality audits, ensure the collection of data for improvement analysis and prepare reports as requested.
• Document the outcome of calls and referral acceptance in an automated manner.
• Access payer fact sheets to determine if the terms of the contract are covered.
• Work with the Patient Registration team, contracted providers and patients to identify potential solutions as clinical problems are identified with payer sources.
• Contact referral sources to advise them of referral status. Relays referral and utilization information to the clinical team who will deliver the services requested.
• Assist team in implementing and maintaining standardized operational processes to ensure compliance to company policies, legal requirements and regulatory mandates.

Customer Service Representative - Faneuil (Access Health Ct)

(2016-08 - 2018-01)

• Answering Calls and Documenting calls at a high rate with less than one minute wrap up time
• Making outbound calls and fixing applications as a certified application counselor
• Floor support- Assisting representatives with their calls and de escalating supervisor call request server/bartender - Red Robin - Manchester, CT

(2013-06 - 2013-08)

• Distributing food to the customers
• Handling large amount of cash and deposits.
• Making sure all customers are fully satisfied before leaving the restaurant server/host - Olive Garden - Manchester, CT

(2012-12 - 2014-06)

• Greeting and giving a warming friendly smile at the door
• Distributing food to customers receptionist - Career Services - Providence, RI

(2012-07 - 2013-06)

• Greeting visitors with a friendly smile in person or by phone
• Taking phone calls
• Making appointments

BS DEGREE - Business Entrepreneur Management - Johnson & Wales (2012-09 - 2016-05)