Cecilia M Hamer
Munster
Summary
Seasoned Utilization Review Coordinator with experience in healthcare management, particularly in monitoring and managing patient care compliance. Strengths include in-depth knowledge of medical terminology, ability to interpret and apply clinical data for effective utilization review, and capability to liaise between medical staff and insurance companies for optimal patient outcomes. Previous roles have demonstrated success in implementing process improvements for increased efficiency and improved quality of care, and strong leadership skills.
Overview
14
14
years of professional experience
5
5
years of post-secondary education
1
1
Certification
Work History
Utilization Review Coordinator
Health Care Service Corporation
Chicago
12.2018 - Current
- Reviewed medical records for compliance with utilization management guidelines.
- Coordinated communication between healthcare providers and insurance representatives.
- Analyzed patient data to determine appropriate levels of care.
- Established and maintained documentation processes for utilization review cases.
- Educated staff on utilization management policies and procedures.
- Collaborated with clinical teams to optimize patient outcomes through effective resource use.
- Provided training to other staff members on utilization management processes and procedures.
- Analyzed medical records to ensure compliance with regulatory requirements.
- Ensured that all documentation is complete and accurately reflects the services provided by physicians.
- Facilitated resolution of disputes between providers, hospitals, managed care organizations, and other entities involved in providing healthcare services.
- Assessed the appropriateness of length of stay for inpatient admissions.
- Coordinated patient transfers between facilities when medically necessary.
- Conducted utilization review activities including concurrent reviews, retrospective reviews, and discharge planning.
- Referred cases to secondary review for failure to meet criteria.
Case Manager
Health Care Service Corporation
Chicago
03.2018 - 12.2018
- Managed case files and documentation for compliance with company policies.
- Assisted clients in accessing community resources and support services.
- Facilitated communication among patients, families, and healthcare teams effectively.
- Evaluated client needs through comprehensive assessment tools and interviews.
- Developed and maintained strong relationships with clients to enhance engagement.
- Conducted regular follow-ups to monitor patient progress and adjust care plans accordingly.
- Provided case management services including intake, assessment, crisis intervention, advocacy, referral and monitoring of families.
- Monitored client progress through regular follow-up contacts.
- Maintained accurate case records and documentation according to agency guidelines.
- Assessed clients' needs, developed service plans and monitored progress towards goals.
- Counseled clients on available resources within the community that could help meet their needs.
- Facilitated communication between clients, families, caregivers, social services and other agencies to ensure client needs were met.
- Developed trusting relationships with social services, health care providers and governmental agencies.
- Developed individualized care plans with input from clients and their families.
- Participated in regular team meetings and in-house training sessions to boost group effectiveness.
- Compiled reports on cases and submitted them to supervisors as required.
- Participated in interdisciplinary team meetings to discuss treatment options.
- Assisted individuals with eligibility for available benefits.
- Reviewed treatment plans against individual goals and healthcare standards.
- Supported family members by providing information on local support groups.
- Identified barriers to client success and developed strategies to overcome them.
- Coordinated comprehensive care plans for clients to meet their individual needs.
- Educated clients and their families about their rights and available community resources.
- Maintained confidentiality and adhered to professional ethics and standards.
- Provided referrals to appropriate medical, mental health, and social services.
- Managed caseloads effectively, ensuring timely documentation and reporting.
Case Manager
Help At Home Health Care
Crown Point
06.2013 - 06.2014
- Managed case files and documentation for compliance with company policies.
- Assisted clients in accessing community resources and support services.
- Facilitated communication among patients, families, and healthcare teams effectively.
- Evaluated client needs through comprehensive assessment tools and interviews.
- Developed and maintained strong relationships with clients to enhance engagement.
- Conducted regular follow-ups to monitor patient progress and adjust care plans accordingly.
- Provided case management services including intake, assessment, crisis intervention, advocacy, referral and monitoring of families.
- Monitored client progress through regular follow-up contacts.
- Maintained accurate case records and documentation according to agency guidelines.
- Assessed clients' needs, developed service plans and monitored progress towards goals.
- Counseled clients on available resources within the community that could help meet their needs.
- Conducted home visits to assess the safety of living environments for clients.
Registered Nurse, Labor and Delivery
Franciscan Physician Network
Dyer
01.2012 - 06.2013
- Provided direct patient care during labor and delivery processes.
- Monitored fetal heart rates and maternal vital signs consistently.
- Assisted in developing individualized birth plans with patients and families.
- Collaborated with multidisciplinary teams to ensure patient-centered care.
- Educated patients on labor progression and pain management options.
- Administered medications and performed necessary medical interventions promptly.
- Documented patient assessments and care plans in electronic health records accurately.
- Provided postpartum care for new mothers, including assessments, education and counseling.
- Consulted with physicians and other members of care team to identify and assist with complications.
- Maintained a safe environment for both mother, baby before, during and after labor, delivery.
- Assisted in the delivery of newborns, providing guidance and support to mothers during labor and delivery.
- Provided assessment of high-risk obstetric patients on admission to Labor and Delivery Unit.
- Discharged mothers and babies after patiently guiding parents through at-home care and follow-up medical care.
- Cared for pregnant women expecting imminent birth and for babies immediately after birth in hospitals and health clinics.
- Performed emergency resuscitation measures such as cardiopulmonary resuscitation.
- Assessed and documented physical condition of mothers and babies and assisted doctors in identifying and treating preeclampsia.
- Briefed next-shift nurses thoroughly on condition, status, and needs of mother and newborn.
- Trained and mentored staff members in obstetrics nursing and care.
Education
Bachelor of Science -
Indiana University, Northwest
Gary, IN 01.2005 - 05.2010
Skills
- Medical record review
- Utilization management
- Team Lead
- Trained groups in PDN & IFM waivers
Languages
Spanish
Elementary
Certification
- Indiana RN compact state license
- Minnesota RN state license
Timeline
Utilization Review Coordinator
Health Care Service Corporation
12.2018 - Current
Case Manager
Health Care Service Corporation
03.2018 - 12.2018
Case Manager
Help At Home Health Care
06.2013 - 06.2014
Registered Nurse, Labor and Delivery
Franciscan Physician Network
01.2012 - 06.2013
Bachelor of Science -
Indiana University, Northwest
01.2005 - 05.2010