Summary
Mid level utilization review therapist with 5 years of experience in case management, DSM-5 assessments, and utilization management. Skilled in analyzing medical data, coordinating care, and guiding team members to improve patient outcomes.
Experience
- Analyzed medical data for 25 cases daily, recommending treatment plans that improved patient outcomes by 18.
- Applied DSM-5 and ASAM criteria to assess admission and discharge appropriateness, reducing non-certified days by 22.
- Coordinated care with clinical and billing teams, resulting in a 15 improvement in reimbursement accuracy.
- Coached 4 utilization management team members, increasing team productivity by 12.
- Managed a caseload of 40 patients, ensuring compliance with medical necessity and payer requirements.
- Collaborated with healthcare providers to clarify documentation, reducing claim denials by 10.
Education
Courses
- Licensed Professional Counselor (LPC), Texas State Board of Examiners of Professional Counselors
- CCM Certification, Commission for Case Manager Certification