Shadia Berrios
Toa Baja
Summary
Proven Utilization Review Coordinator with a track record of enhancing service utilization improvements and compassionate patient care at MMM Holdings. Expert in utilization management and adept at documentation review, significantly boosting operational efficiency. Skilled in devising care plans and streamlining authorization processes, demonstrating a strong commitment to high-quality patient outcomes.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Utilization Review Coordinator
MMM Holdings
Hato Rey, PR
12.2012 - Current
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Performed admission reviews based for medical necessity based upon Type specification.
- Obtained authorizations from multiple insurance carriers for various levels of care.
Utilization Review Coordinator
PSI Psychiatry Solutions
Guaynabo, PR
11.2008 - 11.2012
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Supervised and maintained all utilization review documentation through Software.
- Devise or identify solutions for irregular requests and issues.
Case Manager
FHC
Rio Piedras, PR
08.2005 - 08.2007
- Helped patients receive appropriate, high-quality care with reasonable results.
- Managed support services and fostered communication among social workers, therapists, hospital staff and patients.
- Consulted with clinicians to devise and manage ongoing care plans for at-risk patients.
Education
Master On Counseling In Mental Health - Counseling
University of Phoenix
Tempe, AZ10.2004
Bachelor Of Arts - Psychology
Univeridad Interamericana
Cupey01.2000
Skills
- Utilization Management
- Compassionate and Caring
- Service Utilization Improvements
- Documentation Review
Certification
- Prevention especialist in substances abuse
Certification
Prevention especialist in substances abuse
Timeline
Utilization Review Coordinator
MMM Holdings
12.2012 - Current
Utilization Review Coordinator
PSI Psychiatry Solutions
11.2008 - 11.2012
Case Manager
FHC
08.2005 - 08.2007
Master On Counseling In Mental Health - Counseling
University of Phoenix
Bachelor Of Arts - Psychology
Univeridad Interamericana