Candidate Information Name Available: Register for Free Title Case Management High Risk Target Location US-WV-South Charleston Email Available with paid plan Phone Available with paid plan	20,000+ Fresh Resumes Monthly     View Phone Numbers     Receive Resume E-mail Alerts     Post Jobs Free     Link your Free Jobs Page     ... and much more Register on Jobvertise Free
Search 2 million Resumes Keywords: City or Zip:	Related Resumes Registered Nurse Case Manager Huntington, WV Case Manager Heavy Equipment Saint Albans, WV High School Vice President Charleston, WV Case Coordinator Nitro Office Manager Sales Yawkey, WV Delivery Driver Kitchen Manager Elizabeth, WV Planning/Production Manager Milton, WV

Candidate's Name , BA, RN, CCMStreet Address  Virginia Avenue SECharleston, WV Street Address
PHONE NUMBER AVAILABLEEMAIL AVAILABLEAetna a CVS Health Company, remoteSeptember 2015  December 2022Transplant Case Management/Utilization Management:Performed telephonic case management for transplant patients.(bone marrow, heart, lung, kidney, liver)Responsible for management of patients through the continuum of care for the four phases of transplantation (evaluation, procurement, transplant, 180 days post- transplant).Responsible for facilitating consistent communication data analysis to ensure that all cases are handled appropriately.Responsible for high-risk assessments, medication reconciliation and care plans.Responsible for intensive patient education on diagnosis, treatment plan, immunosuppression, management of side effects and steps to recovery for best outcomes.Responsible for coordination of inpatient case management needs to ensure safe, timely discharge and coordination of discharge needs.Responsible for network steerage and network contracting with transplant centers of excellence.This position required extensive clinical research using resources such as: NCCN Guidelines, Clinicaltrial.gov and Aetna Clinical Policies Bulletin (CPB) guidelines.Responsible for all transplant related authorizations using Milliman Care Guidelines including Physician Review preparation for all transplants.CenCal Health, Santa Barbara, CaliforniaOctober 2014  September 2015Case Management/Utilization ManagementResponsible for management of Medicaid Members for Santa Barbara and San Luis Obispo Counties.Responsible for assisting members in accessing local programs for medical, housing, transportation and emotional needs.Attended and participated in interdisciplinary meetings for care coordination for best patient outcomes.Responsible for high-risk assessments, medication reconciliation and care plans.Responsible for patient education and emotional support for members with various social- economic challenges.Responsible for utilization management for acute inpatient and outpatient needs using InterQual Clinical Guidelines.Responsible for coordination of inpatient case management needs to ensure safe, timely discharge and coordination of discharge needs.Responsible for Physician Review for authorizations that did not meet medical requirements. Heritage Provider Network, Los Angelos, California May 2013  October 2014Case ManagementResponsible for telephone and on-site clinic case management of Medicare SNP members and Glendale high-risk members.Responsible for facilitating consistent communication data analysis to ensure that all cases are handled appropriately.Responsible for high-risk assessments, medication reconciliation and care plans.Responsible for coordination of inpatient case management needs to ensure safe, timely discharge and coordination of discharge needs.Attended and participated in interdisciplinary meetings for care coordination for best patient outcomes.Provided extensive patient education for disease process/management, for related co- morbidities, medication management, and signs/symptoms to report.Participated in after-hour on-call via PALS Line, covering Los Angelos, Burbank, and San Fernando Valley.Participated in weekend on-call follow-up for all discharged patients on Friday; including coordination of care as needed.Previous Experience:Cedar Sinai Medical Center, Beverly Hills, California: Staff RN - Liver/Kidney TransplantSaint Thomas Hospital, Nashville, Tennessee: Staff RN - Cardiac Telemetry/Heart FailureH. Lee Moffitt Cancer Hospital, Tampa, Florida: Staff RN - Bone Marrow TransplantVanderbilt University Medical Center, Nashville, Tennessee: Bone Marrow Transplant CoordinatorEducation/License/Certification:Hobe Sound Bible College: BA Music EducationParkland College: Associate degree NursingTennessee Department of Health: RN PHONE NUMBER AVAILABLE/compact states, expiration: 12/31/2023Certified Case Manager (CCM), expiration: 05/31/2025