Bruce Deeble
Harveys Lake,PA
Summary
Hands-on professional proudly offering more than 11 years of expertise in Utilization Review. Well-rounded and personable Utilization Review Specialist talented in fighting for the days our clients need.
Overview
11
11
years of professional experience
Work History
Utilization Review Specialist
Independent
05.2020 - Current
- Manage caseloads through the process of initial analysis, concurrent review, collaboration and consultation to obtain maximum reimbursement.
- Establish patients' current insurance information and determine reviewing facility.
- Assist admission by participation in pre-certification process.
- Collect and provide an initial and/or concurrent review of the patients' clinical status for reimbursement companies based on their initial and continued stay care criteria.
- Negotiate with providers regarding patient treatment needs.
- Perform all above duties in a timely manner, which requires on site availability 7 days a week and 24 hour availability via cell phone.
- Identify and report variations in the quality and appropriateness of care in all cases using criteria established and approved by the clinical staff, (i.e. Utilization Management, Risk Management, Quality Assurance, ADP) and JCAHO.
- Demonstrate clinical competency.
- Cooperate and communicate effectively with peers, medical/clinical team members and physicians.
- Accept responsibility for direct communication when interpersonal problems or conflicts arise. Follow appropriate communication channels through organizational structure.
- Observe confidentiality of patient information and HIPPA regulations.
- Maintain positive working relationships. Demonstrate the ability to utilize critical thinking and resolve conflict.
- Adapt to changes in a positive manner, giving constructive feedback. Work as an effective team member, collaborating with other disciplines in the provision of care.
- Support a problem-solving approach to both department and patient needs..
- Identify performance improvement opportunities and participate in quality improvement endeavors.
- Communicate effectively in oral and written format.
- Maintain effective interpersonal relationships.
- Understand and apply state, federal and local regulations and laws governing quality assurance and utilization review.
- Work independently.
- Analyze treatment plans, which include the diagnosis of client behavioral and emotional problems.
- Use good judgment in order to make critical decisions about the medical necessity of treatment.
- Work in a high stress, chaotic environment.
Utilization Review Specialist
Zealie
10.2020 - 03.2024
- Utilization Review
- Training
- Case Management
- Process Development
Utilization Review Specialist
Evolve Growth Initiatives
12.2017 - 03.2020
Utilization Review Specialist
Clean Path Recovery
08.2015 - 03.2018
- Pre certification, concurrent, peer to peer, discharge reviews in a substance abuse facility.
- Case management.
Utilization Review Specialist
Sovereign Health Group
11.2014 - 04.2017
Weekend Supervisor
Beachside Recovery, LLC.
08.2015 - 11.2015
- Planning weekend events, daily routine of pickup and drop off of clients, client care. Organizing and executing activities.
- I helped iron out some of the policies and way things were done to help streamline duties and day to day activities.
Education
High school or equivalent -
Skills
- Utilization Management
- Peer Review
- Discharge Planning
- Utilization Review
- Managed Care
- Ability to work in high stress environments
- Highly Autonomous
- Expert in all insurance carriers
Personal Information
- Title: Utilization Review Specialist
- Work Permit: Authorized to work in the US for any employer
Timeline
Utilization Review Specialist
Zealie
10.2020 - 03.2024
Utilization Review Specialist
Independent
05.2020 - Current
Utilization Review Specialist
Evolve Growth Initiatives
12.2017 - 03.2020
Utilization Review Specialist
Clean Path Recovery
08.2015 - 03.2018
Weekend Supervisor
Beachside Recovery, LLC.
08.2015 - 11.2015
Utilization Review Specialist
Sovereign Health Group
11.2014 - 04.2017
High school or equivalent -
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