Kanesha Kelly
@kaneshakelly
Healthcare utilization management professional delivering prior authorizations, care coordination, and compliant clinical documentation for Medicaid and Medicare.
United StatesWhat I'm looking for
I’m a healthcare utilization management professional with 10+ years supporting Medicaid and Medicare populations in managed care environments, with a focus on utilization management support, prior authorization processing, care coordination, and clinical documentation review. Across remote roles, I’ve consistently communicated with providers and members to obtain and verify clinical information, support authorization workflows, and ensure CMS-aligned documentation.
In my recent Outreach & Engagement Specialist work, I conducted outbound calls to verify admission status and discharge planning, supported care coordination to ensure an appropriate level of care, and documented clinical updates in EHR systems in compliance with CMS guidelines. I’m at my best in high-volume, metric-driven settings—identifying care gaps, escalating medically necessary concerns to clinical staff when needed, and maintaining accurate records that support quality and regulatory standards.
Experience
Work history, roles, and key accomplishments
Outreach & Engagement Specialist
Magellan Behavioral Health
Jul 2022 - Sep 2025 (3 years 2 months)
Conducted outbound provider and member calls to verify clinical information and support admission/discharge planning while assisting utilization management and care coordination. Documented clinical updates in EHR systems in compliance with CMS guidelines and supported authorization workflows.
Virtual Customer Care II
Magellan Behavioral Health
May 2021 - Jul 2022 (1 year 2 months)
Assisted with prior authorization requests by gathering clinical documentation from providers and escalating cases for medical necessity review. Managed high-volume inbound/outbound communications and maintained compliant documentation in accordance with regulatory standards.
Customer Service Representative
Louisiana Healthcare Connections
Jul 2020 - May 2021 (10 months)
Handled inbound and outbound calls for benefits, referrals, and prior authorization requirements while educating members and providers on coverage guidelines. Documented interactions to support care coordination and authorization-related service delivery.
Lead STARS Member Navigator
UnitedHealthcare
Apr 2017 - Oct 2019 (2 years 6 months)
Performed health risk assessments and supported care plan implementation by coordinating with providers and members to improve access to appropriate services. Supported preventive care initiatives aligned with CMS STAR measures and maintained required documentation in EHR systems.
Education
Degrees, certifications, and relevant coursework
Southern University and A&M College
Bachelor of Science, Criminal Justice
Bachelor of Science in Criminal Justice program (in progress) at Southern University and A&M College.
Availability
Location
United StatesAuthorized to work in
Job categories
Skills
Interested in hiring Kanesha?
You can contact Kanesha and 90k+ other talented remote workers on Himalayas.
Message KaneshaFind your dream job
Sign up now and join over 100,000 remote workers who receive personalized job alerts, curated job matches, and more for free!
