Deana Marshall

Managed Medicare appeals from skilled nursing facilities and Home Health through Livanta, operating within a highly regulated utilization management and compliance department. Oversaw timely denial processing across all lines of business, including Commercial, Medicare, Federal, Self-Funded, and Medi-Cal, ensuring all documentation complied with regulatory requirements.

Managed care coordination, discharge planning, utilization review (pre-service and post-service), and denials management for a large managed Medicaid program. Applied Milliman criteria for medical necessity and medical review, and conducted claim reviews for DME, pharmaceuticals, and outpatient procedures.

Oversaw management and coordination of a quality improvement pay-for-performance initiative in long-term care, tracking all program metrics. Conducted data analysis and tracking/trending of quality measures, leading performance improvement plans for each center.

Supervised six RN Care Managers and four coordinators in a busy MAPD/D-SNP Case Management and Utilization Management department. Managed complex cases and tracked daily staff metrics for Medical Director review, while maintaining a small CM caseload with continued UM responsibilities.

Provided UM oversight for delegated shared-risk opportunity medical groups, conducting daily written and verbal communication and reviewing clinical documentation for medical necessity of admissions. Managed complex cases with Medical Directors and wrote summaries for potential denials, ensuring Continuity of Care (COC) for difficult member transitions.

Obtained a Bachelor of Science in Nursing (BSN) from San Francisco State University. This education fulfills the certification and education preferences for the role, providing a strong foundation in nursing principles and practices.