Highly experienced and energetic RN with proven clinical expertise and skills in leadership. Committed to supporting the interdisciplinary team with case management, specifically utilization review, claims review, clinical appeals, as well as workers compensation. Adaptable and resilient with extensive knowledge of the insurance industry. Passionate about implementing processes to improve patient care.
Medical Management and Cost Containment through Drug Diversion.
Account: New Jersey School Board Association Insurance Group
● Carried a caseload of up to 65 cases on a daily basis
● Worked with Adjusters at NJSB to determine causality of injury and other coverage issues.
● Scheduled appointments for patients with specialist and monitored care for appropriateness and utilization.
● Worked with School Board contacts to keep them informed of patient's progress and return to work dates.
● Participated in Case Review Conferences.
● Performed Field Visits when necessary.
New Jersey RN License – 26NR05309400
Certified Case Manager, April 2016
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