Rachida Mrabet
Allentown
Overview
22
22
years of professional experience
Work History
Health Services Coordinator
Village Care
New York
06.2024 - 04.2025
- Responsible for the timely authorization and renewal of services for members. Works in collaboration with members of the Utilization Management Department, Care Management Department, and external vendors in order to ensure that authorizations for services are completed timely, correctly, and comprehensively. Accurate processing of authorizations for new and existing member services, including but not limited to eligibility verification, benefit verification, review of prior authorization activity, appropriate certification dates, processing of service request forms, and telephone notes within regulatory time frames, ensures timely notification and coordination with external service vendors for all authorized services.
Utilization Management Representative
ArchCare at Terence Cardinal Cooke Health Care Center
New York
04.2012 - 05.2024
- Creates regulatory-required member communication documents, such as extension letters and Initial Adverse Determination letters. Reports any barrier or delay in the authorization process to the Utilization Management Director or Associate Director. Timely modification or adjustment of authorization is based on vendor communication and member episode. Telephonic and email communication with vendors is used to coordinate service delivery. Obtains assistance and direction from the Utilization Management Director or Associate Director for complex and difficult service requests or authorizations.
Quality Control Coordinator
Health Plus, PHSP
Brooklyn
08.2003 - 01.2012
- Designed Performance Improvement (PI) goals for underperforming departments and individuals
- Coordinated daily quality control for Customer Services representatives.
- Supervised for quality and listen to live or recorded calls.
Education
Some College (No Degree) - Nursing Education
BMCC
New York Skills
- Authorization processing
- Eligibility verification
- Benefit verification
- Regulatory compliance
- Service coordination
- Customer relationship management
Timeline
Health Services Coordinator
Village Care
06.2024 - 04.2025
Utilization Management Representative
ArchCare at Terence Cardinal Cooke Health Care Center
04.2012 - 05.2024
Quality Control Coordinator
Health Plus, PHSP
08.2003 - 01.2012
Some College (No Degree) - Nursing Education
BMCC
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