Violeta V.
Focused on Improving Healthcare Services and Outcomes
- Role
- Director of Utilization Management at Acadia Healthcare
- Location
- Riverside, CA, US
- LinkedIn followers
- 500 followers
About Violeta V.
I\'m dedicated to holistic care and data-driven solutions. Seeking to connect with professionals and organizations that champion healthcare innovation and community well-being.
Experience
Director of Utilization Management
Jul 2024 — Present
Oversees the Utilization Management department at an 80-bed inpatient behavioral health hospital, ensuring appropriate level-of-care determinations and payer compliance for patients with mental health disorders. Manages Treatment Authorization Requests (TARs), concurrent reviews, and retrospective coordination in accordance with Medi-Cal, traditional Medicare, and managed Medicare guidelines, as well as commercial insurance policies.Leads the preparation and submission of retroactive reviews and appeals, compiling clinical documentation to dispute denials and recover reimbursement. Monitors denial trends and implements corrective strategies to improve authorization outcomes and financial performance.Ensures regulatory compliance with state and federal requirements, Joint Commission standards, and payer-specific protocols. Provides staff training and technical oversight on systems such as WellSky, DrFirst, and payer authorization platforms.Collaborates cross-functionally with clinical and business office to support efficient workflows and high-quality patient care.
Education
California State University-San Bernardino
Bachelor of Arts - BA
Western Governors University
Master of Business Administration - MBA
2024 — 2025
Loma Linda University
School of Behavioral Health
2020 — 2023
College of the Desert
Associate of Arts and Sciences - AAS
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