PEDRO RIVERA SANTANA
Mayagüez
Summary
Reliable individual bringing 5 years of experience in healthcare environments. Maintains positive relationships with case managers and providers. Remains polished and calm under extreme stress.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Utilization Review Coordinator (Physician)
METRO PAVIA
02.2021 - Current
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Performed prior authorization review of services requiring notification.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
- Performed admission reviews based for medical necessity based upon [Type] specification.
- Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
- Supervised and maintained all utilization review documentation through [Software].
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
Physician Assistant
Dr. Angel Lopez
01.2019 - 01.2021
- Conducted physical examinations to assess patients' health and current condition for optimal treatment.
- Established continuity of care by completing patient management plans and paperwork by deadlines.
- Completed in-depth physical evaluations and gathered patient medical data to complete speedy, successful office visits.
- Complete Annual Health Assesments
In Home Assessment Physician
SCREENING UNIT CORP
08.2018 - 12.2019
- Collaborated with consulting physicians regarding care of patients.
- Assessed, diagnosed and treated emergency and chronic medical conditions.
- Instructed patients and families on medical diagnoses and treatment options.
- Accessed patient health through interviews and physical examinations.
- Thoroughly examined patients and elicited medical history data to use in assessing health and identifying conditions.
- Integrated patients' files with robust electronic health record system.
- Evaluated patient histories, complaints, and current symptoms.
- Collected, recorded and maintained patient medical history, reports and examination results.
- Educated patients and families on health conditions to raise awareness.
Education
M.D. -
University of Health Science
Antigua06.2016
Bachelor of Science - Biology
University of Puerto Rico
Mayagüez, Puerto RicoSkills
- Case Review Expertise
- Professionalism
- Conflict Resolution
- Time Management
- Critical Thinking
- Clinical Knowledge
- Utilization Management
- Utilization Review
- Interpersonal and Written Communication
- Electronic Medical Record Software
- Healthcare Regulations
- Problem Solving
Certification
- Licensed Physician Assistant 177-PA - [Timeframe]
Languages
Spanish
Native language
English
Advanced
C1
Timeline
Utilization Review Coordinator (Physician)
METRO PAVIA
02.2021 - Current
Physician Assistant
Dr. Angel Lopez
01.2019 - 01.2021
In Home Assessment Physician
SCREENING UNIT CORP
08.2018 - 12.2019
M.D. -
University of Health Science
Bachelor of Science - Biology
University of Puerto Rico
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