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Click here or scroll down to respond to this candidateCandidate's Name
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PHONE NUMBER AVAILABLE EMAIL AVAILABLEProfessional Overview30+ years of clinical experience as a Registered Nurse in various settings10+ years experience in Case Management and Utilization Management10+ years experience in supervisory and leadership roles with extensive practice in training, staff development, and educationProficient in using computer applications such as Word, Excel, Outlook; familiar with InterQual; comfortable using medical chart format including Electronic Medical Records20+ years Registered Nursing experience in the state of New Jersey10+ years Registered Nursing experience in the state of PennsylvaniaProfessional ExperienceAETNA, Bethlehem, PA 2019 to PresentCase ManagerWork in close telephonic collaboration with patients and families, the medical team, and interdisciplinary team members to provide comprehensive services to the insured.Review all documentation from specialists and consult with physicians and therapists.PRIME HEALTHCARE, Bristol, PA 2014 to 2019Senior Case ManagerManages, analyzes, and coordinates the daily activities of the unit to ensure departmental productive goals are met with regard to quality timeliness, accuracy and consistency of medical decisions.Performs evaluations of workflows and improves processes that impact the department.Acts in expert role to resolve difficult and complex matters.Represents the plan with external customers, providers and agencies; represents the department on internal committees and participates in special projects.Performs utilization management for members from enrollment, pre-certification, and utilization management to discharge addressing all transitions of care.Identifies and implements cost saving/revenue generating opportunities.Assists the director in coordinating regulatory, quality, and accreditation activities.Leads the team of case managers and provides mentoring to staff members.ACCOLADE INC, Plymouth Meeting, PA 2013 to 2014Clinical Health AssistantTriage telephone calls from patients in behavioral health and medical triage; use computerized database to facilitate access to necessary parties.Work closely with providers, nurses, insurance companies, patient families, and all other members of the organization by teaching, communicating therapeutically, and negotiating solutions.Responsible for staging care and directing patients to providers.Listen, demonstrate empathy, and utilize problem-solving techniques to resolve patient concerns.Conduct full behavioral health assessments, educate patients on their roles in their treatments, and aid them in accessing healthcare solutions.Follow up on patients with chronic conditions and assist patients to get appropriate care in compliance with treatments.Negotiate billing, identify insurance processing errors, and arrange payment plans on behalf of patients.TEMPLE UNIVERSITY HOSPITAL, Philadelphia, PA 2009 to 2013Case Manager, (2009 - 2013)Earlier CareerARIA HEALTH, Philadelphia, PA 2004 to 2009Catheterization Lab Nurse & Telemetry NurseCARRIER CLINIC, Belle Mead, NJ 2001 to 2003Adolescent Psychiatric NurseJFK MEDICAL CENTER, Edison, NJ 2000 to 2001Neurological Surgery UnitTRENTON PSYCHIATRIC HOSPITAL, Trenton, NJ 1999 to 2000Head Psychiatric NursePINNACLE HEALTH ENTERPRISES, New Brunswick, NJ 1998 to 1999Case Management Nurse On-site Case ManagementPRUDENTIAL, Linden, NJ 1997 to 1998Workers Compensation Case ManagementVISITING NURSE OF CENTRAL JERSEY, Red Bank, NJ 1994 to 1997Supervisor Clinical Reimbursement of 3 Health CentersPRUDENTIAL, Iselin, NJ 1992 to 1994Case Management Nurse Major Clients & National AccountsPALM BEACH GARDENS HOSPITAL, Palm Beach Gardens, FL 1983 to 1992Invasive Coronary Unit NurseEducation & Professional DevelopmentThomas Edison State College, Trenton, NJBachelor of Science Degree in Nursing (2009)Henry Ford Community College, Dearborn, MIAssociate Degree in Nursing (Cum Laude) & Associate Degree of Liberal Arts (Cum Laude) (1983)Academy of Health Sciences, San Antonio, TXEye, Ear, Nose, Throat Specialist United States Army (1977)CCM CertificationRegistered Nurse in the State of New JerseyLicense Num. 26NR07940200Registered Nurse in the State of PennsylvaniaLicense Num. RN548595 |
