Gipsy Espinoza

Ensured members' access to services appropriate to their health needs and conducted assessments to identify individual needs, developing specific care management plans. Implemented care plans by facilitating authorizations and referrals, coordinating internal and external resources to meet identified needs.

Led the Utilization Review department, overseeing budget and operations while ensuring optimal quality patient care through admission and concurrent reviews. Responsible for staff selection, training, and development, as well as the revision of UR department policies and procedures.

Reviewed patient accounts for medical necessity and managed cases involving insurance denials and appeals on discharged accounts. Performed initial concurrent reviews by providing clinical information to insurance companies to obtain authorizations.

Coordinated patient discharge evaluations for approximately 15 to 20 patients daily, providing discharge summaries to insurance companies to secure coverage. Crafted comprehensive discharge plans for optimal patient well-being and safety, including patient destination and transportation.

Pre-admitted patients by receiving bookings from physicians and confirming admitting privileges. Interviewed patients, conducted assessments, and entered information into the pre-admissions database.

Informed and marketed various insurance plans, including Homeowner's, Car, Life, Commercial, Boat, and Motorcycle Insurance, to potential customers. Focused on explaining policy details and benefits to secure new clients.

Handled secretarial tasks efficiently, including answering phone calls and assisting patient visitors and relatives. Aided nurses and physicians with patient charting by entering patient information and physician's orders, requiring knowledge of medical terminology.

Completed an Associate Degree in Nursing, focusing on fundamental nursing principles and patient care. Acquired essential skills for clinical practice and healthcare settings.

Earned a Bachelor's degree in Psychology, gaining a comprehensive understanding of human behavior and mental processes. Developed strong analytical and research skills applicable to various professional fields.