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Click here or scroll down to respond to this candidateCandidate's Name PHONE NUMBER AVAILABLE EMAIL AVAILABLESeasoned nurse consultant and hands-on nurse with ability to adapt and be flexible to change as priorities evolve. Possess a multitude of skills working in both a business and clinical perspective. Offers well-developed teamwork and communication skills as well as ability to be self-directive, coupled with ability to analyze information to construct effective solutions. Committed to executing results and demonstrates the awareness, attitude, knowledge, and skills to work effectively with a culturally and demographically diverse population. Strong clinical assessment skills and care planning skills. Extensive nursing management experience coupled with proven ability to work collaboratively with multiple health professionals in a busy and complex environment using tact, diplomacy, and discipline. Demonstrated excellence as a practitioner/leader/manager in nursing; brings leadership skills related to client care, the program management model, and collaborative interprofessional practice. Advanced ability to plan, organize, set, and accomplish objectives and goals. Comprehensive knowledge of health care professions and their role in client and family care. Committed to ongoing process improvement and delivering outstanding quality and results.RELATED PROFESSIONAL EXPERIENCETravel/Contract Case Manager, Utilization Review Specialist July 2023- PresentAssess the needs, health condition and treatment plans.Facilitate the needs and care options for patients and other individuals.Advocate for the patients to ensure their needs and goals are met.Develop, implement healthcare plans for patients of all ages.Assist patients and their families understand their health status and treatment options.Ensuring the patient receives the assistance necessary to follow through with their personal treatment plan.Utilization Management Nurse Consultant (Remote), Aetna Insurance Company 2008 July 2023Assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/ benefits for members, ensuring compliance at all times.Evaluate options to facilitate appropriate healthcare services/benefits for members; gather clinical information and applies appropriate clinical criteria, policy, procedure, and clinical judgment to make recommendations.Identify opportunities to promote quality effectiveness of healthcare services and benefit utilization.Delegated as a preceptor; create training material and execute training to new hires.Lead utilization review nursing policies and how to resolve escalated cases in absence of manager.Supervisor of Aetna Student Health Unit; Planed, directed,assigns, and evaluated work of subordinates; Developed and implemented procedures to ensure effective and timely reviews; Evaluated performance of team, coached to ensure continued opportunities; Hired and onboarded new hires; Ensured patients received care needed in most coast effective manner utilizing all available resources.Senior Medical Underwriter, Anthem Blue Cross/Blue Shield 2005 2008 Collaborated with team and provide calculations of group/individual premium rates for new business and renewal in accordance with underwriting guidelines and federal/state statutes.Proposed new business rates for complex cases ensuring rating compliance, utilizing a combination of medical applications, additional medical information, and manual rates.Evaluated medical information and assigned appropriate underwriting decision; monitored and reviewed rating compliance reporting with actuaries for assigned business.Analyzed and responded to written and verbal underwriting inquiries, ensuring timely feedback was given,Regional Underwriting Manager Entrusted to conduct risk assessments, mediation of contract renewals by establishing open lines of communication; selected to lead and oversee sales team (reporting directly to Vice President of Underwriting).Registered Nurse - Home Care & Hospice, Forum Health at Home 2003 2008Managed schedule of patients in the community or in hospice; initiated, implemented, and supervised patient plan of care; executed care and observed, recorded, and reported needs of both acute and chronic illness; carried out care plan of treatment and reports changes as necessary; consulted physician regarding disease and symptom management.Received positive feedback from hundreds of patients due to exceptional delivery of care.Acquired strong proficiency in oasis documentation and obtaining authorization from third party payers.Labor & Delivery Registered Nurse, University of Pittsburgh Medical Center 2001 2007Provided general nursing care to patients before, during, and after labor; monitored patient and ensured comfort.Monitored contractions and helps patient with breathing techniques; performed V and central line skills; administered pain medication as ordered; administers other meds to address specific medical conditions,such as hypertension and diabetes.Read fetal monitor and identified any issues with babys heart rate; identified and managed life-sustaining physiological functions in unstable patients.Delegated to use training/teaching abilities to instruct patients and their families on new baby education, post-partum recovery, health care and disease prevention.EDUCATION/LICENSES/TRAININGMasters Degree, Science of Nursing, MSN, Cleveland State University, Expected 2026Bachelor of Science, Nursing, BSN, Penn State UniversityRegistered Nurse (RN), State of Ohio & State of PennsylvaniaAdditional experience as an RN at St. Elizabeths Medical Center. |
