Patient Care Coordinator - Bella Grace Aesthetics and Wellness - Austin, TX
(2022-01 - 2024-12)
- Navigated multiple complex online health programs and electronic systems daily within a fast-paced environment, ensuring precise data entry and care coordination.
- Demonstrated strong quality leadership and clinical independent judgment to manage daily office operations, protocols, and multi-tasking administrative functions.
Clinical Supervisor - Austin NeuroCare - Austin, TX
(2010-01 - 2015-12)
- Served as a clinical expert to provide staff leadership, education, and development functions aimed at promoting high-quality, legally compliant, and cost-effective healthcare delivery.
- Reviewed and summarized comprehensive new patient records, abstracting precise medical history and clinical data into EMR systems under limited supervision.
- Executed utilization management by performing strict preauthorization assessments for requested radiology procedures, validating clinical necessity and documentation accuracy.
Field Case Manager - Evercare / United Health Plans - Austin, TX
(2010-01 - 2010-12)
- Conducted rigorous patient clinical assessments, utilizing independent judgment to develop comprehensive care plans and perform specialized utilization reviews.
- Ensured strict adherence to state policies, procedures, and regulatory guidance while documenting client clinical profiles and submitting critical funding paperwork to the state.
- Interacted professionally with Texas Medicaid providers, external healthcare agencies, and internal team stakeholders to coordinate continuity of care.
Quality Improvement Coordinator and Case Manager - Superior Health Plans - Austin, TX
(2009-01 - 2010-12)
- Performed clinical reviews of quality-of-care complaints submitted by Texas Medicaid (STAR / STAR+PLUS) members to ensure healthcare system integrity.
- Assured full, strict compliance with NCQA, state, and corporate regulatory measures during all review workflows.
- Executed preauthorization and utilization reviews of requested procedures, checking clinical necessity and documentation standards against Medicaid parameters.
Quality Improvement Coordinator and Case Manager - Associated Neurological Specialties - Austin, TX
(2009-01 - 2010-12)
- Managed telephone triage and patient education in a high-volume neurology environment, optimizing clinical assessment protocols to achieve excellence in quality standards.
Assistant Director / Program Review Specialist - Texas Medical Foundation - Austin, TX
(1997-01 - 2006-12)
- Conducted extensive retrospective reviews and quality monitoring for physician and facility corrective action plans, identifying systemic operational deficiencies and compliance gaps.
- Supervised nursing staff performing utilization reviews, quality-of-care audits, and complaint reviews, covering complex Medicare and Texas Department of Insurance (TDI) Workman's Compensation cases.
- Evaluated medical records to validate the delivery of quality care, medical necessity, and adherence to established contractual, state, and federal regulatory rules.
- Drafted highly complex, detailed summary reports detailing individual review findings for medical cases, effectively communicating technical data to oversight committees.
- Collaborated with external healthcare providers, state stakeholders, and internal colleagues to implement methodologies that minimized waste, enhanced plan effectiveness, and preserved HIPAA standards.
- Strategized with OIG stakeholders when investigating Medicare fraud and abuse.
Nurse Consultant - Texas Medical Foundation - Austin, TX
(2007-01 - 2009-12)
Supervisor – Health Care Services - Foundation Health Federal Services - Austin, TX
(1993-01 - 1997-12)
- Recruited, trained, and managed review nurses in the technical execution of utilization reviews, medical record auditing, and case management across Texas and Louisiana (Region 6 Tricare).
- Directed internal quality monitoring initiatives to evaluate nursing staff auditing accuracy, developing corrective action plans to remedy identified utilization management gaps.
Review Coordinator - Texas Medical Foundation - Austin, TX
(1990-01 - 1993-12)
- Executed detailed retrospective and concurrent utilization reviews for Medicare and Workman's Compensation cases to confirm accurate coding and medical necessity.
Clinical Nurse Advisor - Nutri-System Weight Loss Center
Charge Nurse - Brown's School Alternative Living Center
Staff Nurse / Charge Nurse - Asbury Hospital and Central Texas Oncology
