Robert Sabot

About Robert Sabot

Accomplished healthcare professional with experience in healthcare quality improvement, including the use of HEDIS and other quality measurement tools. Assists, plans, and implements new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of programs for members in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance measurement activities; and provides direction and implementation of NCQA accreditation surveys and federal/state QI compliance activities. Utilizes strong patient education skills, including the ability to help patients navigate healthcare services and access the care they need. Excellent communication skills, with the ability to effectively communicate complex healthcare information to a variety of audiences including members, providers and key stakeholders.

Experience

1. Care Review Processor - Utilization Management

   Molina Healthcare

   Aug 2023 — Present · Long Beach, CA, US

   Performs care coordination activities in collaboration with health care providers, other HCS staff, involved medical case managers, case management processors, community-based organizations (CBOs), and other providers as required to provide timely and accurate service authorizations and integrated care.• Works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. • Accurately interprets specific state and/or federal benefits, contracts as well as additional business requirements and converting these terms to configuration parameters.• Works to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.• Responds to requests for authorization of services submitted via phone, fax, and mail according to Molina operational timeframes.• Contacts physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director.• Provides computer entries of authorization request/provider inquiries, such as eligibility and benefits verification, provider contracting status, diagnosis and treatment requests, coordination of benefits status determination, hospital census information regarding admissions and discharges, and billing codes.

Education

• Freedom High School

  High School Diploma

  2009 — 2012