Kya Letsinger
Utilization Management Manager @Yamhill Community Care
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WORK HISTORY
Utilization Management Manager @Yamhill Community Care
Develops and oversees UM policies and processes to ensure that UM activities, documentation, and reporting supports quality, timely, and compliant deliverables.Collaborates and coordinates across providers and healthcare settings to ensure optimal quality outcomes.Ensures support for the YCCO CMO and/or Associate Medical Director in the provision of peer-to-peer and other review activities.Seeks consultation with CMO, the Associate Medical Director and/or Nursing Director - RN, as needed, to support quality of care.Refers UM issues to the Nursing Director - RN and/or CMO, Associate Medical Director or the CMO in a timely manner and monitors the issue until it is resolved.Collaborates with Care Management team to support members’ successful transitions between levels of care.Ensures member and other communication and notices are composed in a manner consistent with regulatory standards.Ensures effective management of work queues and other UM deliverables.Ensures performance of all necessary UM-related reviews within required timelines or earlier as directed.Collaborates with internal and external entities in order to support the successful resolution of medical necessity and other reviews.Provides consultation regarding UM to physicians and other colleagues within the Yamhill Health system working in collaboration with the CMO, Nursing Director – RN and Provider Relations.Ensures that UM staff are consistent in conducting medical necessity review/appeals to ensure appropriateness of care.Documents UM, quality, and risk concerns and refer to appropriate departments as applicable for follow-up
EDUCATION
Old Dominion University
Bachelor of Science - BS
Florida State University
Master of Business Administration - MBA
ABOUT KYA LETSINGER
I’m a mission-driven Registered Nurse and healthcare leader with over a decade of…
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