Workers Compensation / Utilization Review / Occupational Medicine
Wellness Education / Industrial Health / Ergonomics
Key Qualifications -
Compassionate and focused on patient-centered care, apply active listening skills and proactive communication talents while educating patients; bilingual English and Polish.
Dedicated to aligning cost control objectives and risk management goals with healthcare and medical treatment recommendations governing care plans and clinical service utilization. MS Office (Word, Outlook, PowerPoint), WICS, Nextgen, Cerner, CMS, Active Health, GroupWise, BRIO, SightReader, FaxCom client, and Avaya phone system.
Telephonic Nurse Case ManagerMar 2015 to Current Genex Services － Anaheim, CA
Responsible for assessment, planning, coordination, implementation and evaluation of individuals on Workers' Compensation and Disability /disabled individuals.
Working as an intermediary between carriers, attorneys, medical care providers, employers and employees, closely monitoring the progress of the injured worker and report results back to the employer and insurance carrier Lead the Return-to-Work Program in designated area Prompt case status summaries make recommendations for safe returns to work Monitoring and weekly reports provide important updates Medical management Continual client-specific case reporting Data collection and outcome analysis.
AMBULATORY NURSE CASE MANAGEROct 2013 to Mar 2015 Banner Health － Greeley, CO
Provided case management for 3K yearly cases for patients with Medicaid and private insurance coverage to determine and guide healthcare service utilization to meet patient needs while reducing cost and optimizing resources.
Compile, monitor, and report on utilization patterns and care progress to facilitate options aligned with goals; assess quality of clinical care, identify care barriers, and create plans in coordination with medical providers, payers, and patients to handle plans for care, discharge, transfer, and other requirements to meet managed care goals.
Selected Contributions: Effectively created a collaborative team environment highly supportive of patient outcomes, risk mitigation, and resource maximization.
Skillfully educated internal and external healthcare teams on case management strategies.
Recognized for going above and beyond to meet patient care needs while aligning service provisions with cost control objectives.
NURSE CASE MANAGER / NURSE SPECIALISTSep 2001 to Oct 2013 Pinnacol － Denver, CO
Directed full scope administrative process for case management for 1K patients per year, as related to Worker's Compensation healthcare claims.
Handled policies for large employer's cases.
Consulted with patients on injuries and provided advocacy, education, and nurse coaching services as a telephonic nurse case manager.
Communicated with employers, medical providers, and allied professionals to create and promote programs to reduce rates of injury and disease at employer's work sites.
Researched, reviewed, and reported on health agency regulations.
Authorized medical procedures (surgeries, injections, DME, medications, PT, OT, prosthesis); advised patients on denials.
Developed modified duty tasks for employees / employers.
Liaised with risk prevention and return to work specialists and OSHA inspectors.
Adhered to HIPAA regulations.
Prepared recommendations for settlement proposals.
Trained support team members and allied professionals.
Selected Contributions: Continuously ranked in the Top 10% of all nurse case managers in recognition for exceptional performance, compassion, and dedication to excellence for all patients.
Proactively recommended exposure reduction plans to decrease risks for injuries and illnesses at workplaces; advised employers and employees on various hazards.
Selected to support employers through providing applicant screening and interviewing during new hire process.
Consulted with companies on work site programs and processes to support risk mitigation and injury reduction operations.
Effectively advised on methods to decrease medical costs and promote closure of old claims through coordinating with attorneys, adjusters, and company decision makers.
Selected to spearhead trainings for multiple professionals including medical claim reviewers, new nursing staff, adjusters, attorneys, medical providers, risk prevention advisors, return to work specialists, and employers.
Rapidly and effectively managed emergency and high-level catastrophic cases demanding rapid response and immediate priority.
Assumed added duties from 2/'09 to 10/'10 as an Expert Resource / Nurse Specialist performing quarterly file reviews for 40 nurses and focused file reviews for the Business Directors; handled utilization management, systems coordination, and quality control.
Medical Disability Nurse Case ManagerLiberty Mutual Insurance － Denver, CO
Handled case management for Worker's Comp cases as a field nurse across a multi-state territory spanning Colorado, New York, Arizona, and Utah.
Occupational Nurse Case Manager / CoordinatorGreeley Medical Clinic － Greeley, CO
Managed care provisions for 1500 injured workers yearly for primary care provider; delivered nurse triage services and provided workplace ergonomic assessments.
Child Health SupervisorWeld County Health Department － Greeley, CO
Contributed to State Health program, Children's Lead Poisoning Health Program, for 150+ children to decrease brain damage risk; supervised 900-children caseload.
Education and Training
Bachelor of Science, NursingUNIVERSITY OF NORTHERN COLORADO － Greeley, CONursing
administrative, agency, Avaya, BRIO, Case Manager, case management, CMS, coaching, cost control, client, Data collection, bilingual English, Ergonomics, GroupWise, HIPAA regulations, injections, insurance, listening, managing, Medical management, MS Office, Outlook, PowerPoint, Word, nursing, Occupational Medicine, clinical care, patient care, phone system, policies, Polish, primary care, processes, progress, proposals, quality, quality control, reporting, research, risk management, triage
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Companies Worked For:
Liberty Mutual Insurance
Greeley Medical Clinic
Weld County Health Department
UNIVERSITY OF NORTHERN COLORADO
Job Titles Held:
Telephonic Nurse Case Manager
AMBULATORY NURSE CASE MANAGER
NURSE CASE MANAGER / NURSE SPECIALIST
Medical Disability Nurse Case Manager
Occupational Nurse Case Manager / Coordinator
Child Health Supervisor
Bachelor of Science , Nursing
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