Chantale Adembuh

Reviewed and monitored utilization of health care services to ensure high-quality, cost-effective care. Coordinated medical necessity reviews for various payers and reviewed clinical documentation to reflect level of service and severity of illness. Performed initial and concurrent reviews and facilitated service delivery through resource utilization.

Advised hospital management on patient care status, budgetary projections, and quality improvement processes. Developed, interpreted, and reviewed policies and procedures, and administered process improvement initiatives. Controlled Human Resources processes including hiring, evaluating, and developing staff.

Delivered expert care and support for cardiac patients, monitored vital signs, and partnered with other medical teams and physicians. Managed an average caseload of 20 patients per week. Provided precertification using InterQual & Milliman, performed telephonic/concurrent review, and ensured medical necessity using nationally recognized criteria.

Collaborated with physicians and assisted with writing orders, scheduling tests, and procedures. Established care plans in collaboration with the patient, family, and healthcare team. Provided health education, assisted with specialized diagnostic and therapeutic procedures, and initiated emergency measures like CPR.

Followed up on physician reports and recommendations with patients and families, acting as a liaison for research study participants. Participated in the presentation of clinical findings and evaluated patient care outcomes. Made hospital rounds and collaborated with physicians on writing orders and assisting with procedures.