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Andrea Groves

Andrea Groves

Clinical Services Coordinator

Quantum Health

Experienced Service Coordinator with a demonstrated history of working in the hospital & health care industry. Skilled in Team Building, Management, Managed Care, Healthcare, and Healthcare Management. Strong healthcare services professional with a Associate of Arts (A.A.) focused in Criminal Justice from University of Phoenix.

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Quantum Health

Clinical Services Coordinator

Work independently with little supervision
Daily calls to providers to secure discharge documentation and utilization reports
Responsible for drafting non-certification letters to advise members of service that are not covered by the plan
Managing daily reports by contacting providers to insure daily clinical information is received and sending suspend letters when needed to control costs to both member and plan
Liaison between both clinical and non-clinical staff; researching clinical issues, answering questions concerning authorizations, and by facilitating nurse reviews and verbal clinical review
Review, distribute and maintain both clinical and non-clinical faxes for two departments
Obtain, record and enter demographic information and request review for all hospitalizations