Miko Choy, MSN, MPA, RN, CCM

Experience

• 

  Joel J. Kassimir, MD

  Jan 2008 - Feb 2010

  RN

  Dermatological Practice

• 

  Elmhurst Care Center

  Feb 2010 - May 2011

  RN / Charge Nurse
• 

  Four Seasons Nursing & Rehabilitation

  Jun 2011 - Dec 2011

  Nursing Supervisor
• 

  NYS Office for People with Developmental Disabilities

  Dec 2011 - Sept 2013

  Nurse Case Manager
• 

  Elmhurst Care Center

  Sept 2013 - Jul 2014

  Nursing Supervisor
• 

  Cassena Care

  Jun 2014 - Jan 2015

  Nursing Supervisor
• 

  L.A. Care Health Plan

  Feb 2015 - Sept 2016

  - Onboarded new case managers to the CalMediConnect (CMC) team and trained existing case manager staff on workflows, responsibilities, and process changes within the department.-Functioned as the subject matter expert (SME) for case management best practices and standards- Identified areas that needed improvement within the department and created job aids and materials to address identified gaps.- Ensured regulatory and accreditation compliance NCQA, DHCS, CMS requirements are met by the department, working closely with Supervisor and Manager - Reviewed policies, procedures and workflows systematically and regularly to ensure that they are current and within standards and that the department is utilizing them as documented. - Facilitated weekly case conference rounds.- Developed data reports to support clinical operations including compliance monitoring Show less

  • Supervisor, Medical Management - CalMediConnect

    Jul 2016 - Sept 2016

  • Lead Medical Management Specialist - CalMediConnect

    Feb 2015 - Jul 2016
• 

  SCAN

  Sept 2016 - now

  - Manages a team of clinical nurses (RN/LVN) and day-to-day clinical UM operations of various lines of businesses- Functions as UM department liaison in collaborating with various internal departments and external business partners to facilitate care- Onboards new staff hires for the department- Ensures department compliance with regulatory CMS, DHCS requirements- Coaches and mentors existing staff on department workflows- Functions as UM department representative in system UAT testing and facilitating needed system updates to align with the department’s needs- Reviews and updates department desktop procedures to align with most current processes and compliance requirements- Functions as UM department’s InterQual Certified Instructor for onboarding and continued training on the most current InterQual clinical criteria Show less - Performed preservice and concurrent review for inpatient acute, ARU, LTAC, SNF, DME, Home Health requests for Out of Area (OOA) and Out of Country (OOC) members-Facilitated care transitions including repatriation back to in-network facilities -Facilitated discharge planning back to service area including coordination of care for any post- OOA/OOC services needed-Functioned as Subject Matter Expert (SME) in clinical criteria including Medicare, Medi-Cal and InterQual guidelines for the department. Show less

  • Manager, Utilization Management

    May 2023 - now

  • Medical Management Supervisor

    Sept 2021 - May 2023

  • Medical Management Specialist - Out of Area

    Jun 2020 - Sept 2021

  • Medical Management Specialist - VillageHealth

    Sept 2016 - Jun 2020