Sinath Sou

Supervised case management and utilization management functions to achieve cost-effective resource utilization. Collaborated with the Director of Operations and Medical Directors to develop, implement, and meet strategic yearly goals for case management and utilization management.

Performed prior authorization and concurrent reviews utilizing evidence-based criteria to ensure appropriate determinations. Collaborated with providers and members on care coordination, discharge planning, and effective utilization of community resources.

Supervised a team of 15 clinicians performing concurrent utilization management reviews for commercial lines of business, including acute inpatient and skilled nursing stays. Managed general supervisory duties such as training, hiring, scheduling, performance conversations, and operational data analysis.

Led a group of 12-15 nurses on a Utilization Management Team, providing onboarding training, updating materials, and assisting with goal metrics and performance evaluations. Performed concurrent reviews using evidence-based criteria and collaborated with other departments to resolve claims, quality of care, and member issues.

Provided family planning and primary care services to adolescents and young adults with a focus on disease prevention and education. Assisted in grant writing, managed outreach activities, and developed community contacts for the school-linked Youth Health Center clinic.

Completed a Bachelor of Science in Nursing, concentrating on acute care and clinical studies. Acquired comprehensive knowledge and practical skills in patient care, health assessment, and clinical decision-making.

Undertook a Bachelor of Science program, completing 2.5 years of general nursing requirements. Focused on foundational scientific and health-related coursework essential for further nursing education.

Earned a Master of Business Administration with a strong emphasis on marketing and management principles. Developed strategic leadership skills applicable to complex organizational environments, particularly within healthcare.