Earlyn Brubaker

• Drove strategic improvements to enhance operational and organizational efficiencies.
• Oversight of utilization management standard reporting development and maintenance
• Prioritized and allocated valuable resources to refocus staff and align processes with business objectives.
• Performed continuous evaluations of business facility, teams and policies to keep operations efficient and consistent.
• Fostered work culture of collaboration and mentorship to increase morale and reduce turnover.

• Oversight of Utilization Management activities across 17 markets
• Lead for development and implementation of UM Standard Operating Practices and authorization system conversion
• Co-Lead for Health Plan Oversight Team responsible for monitoring plan performance and address support needs
• Collaboration with Shared Services Units and across organization in the development of standard operational and informatics reporting, including categorization of authorization types
• Management of team who reviewed and established corporate authorization requirements
• Lead for UM and Letters Business Excellence Workgroups that include systems and process improvements

• Oversight of Utilization Management / Prior Authorization operations
• Facilitated PA Efficiency Workgroup Activities:
• Audit tool revisions to increase focus on quality of documentation and appropriate decision-making
• Revised Peer to Peer Process to improve determination timeliness and minimize rework
• Performed code grid reviews and submitted prior authorization requirement recommendations, targeting services that require in-depth clinical reviews
• Participated in systems stabilization workgroups to maintain compliance standards, streamline processes and improve timeliness of decision making
• Mercy Maricopa Implementation Lead for Prior Authorization & Utilization Management Teams
• Collaborated with team to conduct policy & workflow reviews corresponding to Scope of Work criteria; systems development & hiring, including providing post-go live support
• Facilitate MM/UM Intradepartmental Meeting, including review of utilization data, trends and interventions
• Review and submit regulatory reporting

See 'Director of Clinical Health Services' duties listed above

• Oversee daily operations for Prior Authorization and Special Programs teams
• Efficiency Activities
• Project Lead for Prior Authorization Efficiency Workgroup
• Collaborated with teams to evaluate and improve end-to-end Prior Authorization timeliness
• Developed Outbound Call Process to minimize the time spent by clinicians seeking additional clinical information
• Development of Real-Time PA Monitoring Tool to aid in queue volume management
• Created and transferred CRS, Quality Review and Family Planning tracking functions into QuickBase
• Participated in Code Specific Grid Workgroup, including the following workgroup activities:
• Review of code grid, ProPAT formatting
• Creating summary report related to review results
• Present code grid Exception Requests to the UM Steering Committee
• Project Lead for the MCP Pain Management Committee working to develop decision making ladder to improve utilization practices

• Ensured employee compliance to company and departmental policies and procedures
• Performed monthly staff service observations and provide feedback to ensure adherence to workflows and delivery of professional customer service
• Developed tools to efficiently track departmental and individual progress in line with annual goals
• Coordinated with supervisory and training team in preparation for site audits and accreditation reviews
• Participate in new client implementation workgroups specific to clinical area
• Development of training materials in coordination with clinical training staff
• Identify technical components requiring testing prior to launch of new processes
• Coordinate client specific retrospective Variable Intensity Review audit
• Development of audit and reporting tools
• Ensure timely completion of chart review at the nursing and physician reviewer levels
• Facilitate employee satisfaction activities
• Development and maintenance of department website & monthly newsletter to improve connections between site locations and a growing remote employee population

• Perform charge nurse duties; Coordinate with multi-disciplinary team in case management and development of discharge solutions
• Evaluate, document and report patient information/status throughout shift
• Facilitate and conduct unit activities each shift (i.e., community meetings and goal development)
• Conduct assessments for Crisis Services Urgent Care Observations Program to identify high-risk patients
• Educate patient and family regarding treatment plans and various coping mechanisms

• Conduct case reviews and determine clinical appropriateness of requested imaging studies
• Educate clients and members on criteria utilized to issue determinations and improve consumer understanding of clinical review procedures
• Utilize established tools and standards to expedite case review process