Kajal Patel
Utilization Management II Coordinator - Pioneering Health Equity and Systems Change
- Role
- Utilization Management Ii Care Management Support Coordinator at Healthfirst
- Location
- New York, NY, US
- LinkedIn followers
- 500 followers
About Kajal Patel
As a driven and passionate individual, I am a graduate of Rutgers University - New Brunswick with a degree in Bachelor\'s of Science in Health Administration. Moreover, I attained a minor in Public Health. I have substantial volunteering experience consisting of work in the health sector. My career objective is to inform and improve the community\'s health and push for healthcare reform to enable equal access to various socioeconomic groups. I am very passionate in improving health outcomes working with a Health Administrative team using Public Health\'s core values to continuously improve healthcare costs, accessibility, and quality of healthcare to consumers. Aspiring to become a Health Administrative director in a diverse array of clinical settings, I am highly adaptable and efficient in a fast-paced environment. I streamline healthcare efficiency while driving change in care management. Please feel free to reach me at k••••••••@gmail.com!
Experience
Utilization Management Ii Care Management Support Coordinator
Sep 2024 — Present · New York, NY, US
Provide advanced support to the Utilization Management department, ensuring accurate and timely processing of prior authorizations, concurrent reviews, and post-service requests across various lines of business (Medicare, Medicaid, Commercial).Serve as the first point of contact for providers and internal clinical teams regarding documentation, eligibility, and service request statuses.Enter and track authorization requests using internal systems including EPACES while ensuring compliance with all regulatory and organizational guidelines.Collaborate with RNs and Medical Directors to facilitate clinical reviews and support decisions related to medical necessity and service appropriateness.Maintain detailed records and audit trails for utilization decisions, appeals, and follow-ups, contributing to audit preparedness and compliance.Key Accomplishments:Consistently exceed departmental productivity targets while maintaining high quality and accuracy in data entry and provider communication.Played a key role in improving turnaround times for urgent and expedited requests through improved queue management.Recognized by supervisors for reliability, cross-functional teamwork, and proactive issue resolution.Certifications & TrainingHIPAA Privacy & Security Training – CompletedNCQA & CMS Regulatory Compliance Training – CompletedTechnical SkillsHealthfirst Systems: Trucare Enterprise Care Management Platform, EPACES, RightFaxMicrosoft Office Suite (Excel, Outlook, Word)Claims & Authorization PortalsEHR & Document Management ToolsCall Center & Case Management Systems: Interaction Desktop, Jabber, Twilio
Education
Burlington Township High School
High School Diploma
2014 — 2018
Rutgers University Edward J. Bloustein School of Planning and Public Policy
Bachelors of Science in Health Administration
2018 — 2022
Rutgers University–New Brunswick
Bachelor of Science - BS
2018 — 2022
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