Asa Zuberi
Fayetteville,AR
Summary
Managed care clinical professional with experience in quality, utilization, and care management, applying strong clinical judgment and critical thinking to evaluate cases, identify root causes, and support compliant coverage and determination rationales. Demonstrated success in driving corrective action plans, improving regulatory readiness, and promoting quality outcomes across member-centered operations. Recognized for strengthening service excellence, supporting cross-functional collaboration, and advancing positive member and patient relations within complex managed care environments.
Overview
1
1
Certification
14
14
years of professional experience
Work History
Clinical Quality-of-Care Nurse
VillageCare
New York, NY (Remote)
09.2024 - Current
- Directed 100+ investigations, quarterly, into quality-of-care concerns, grievances, and critical incidents to identify root causes and ensure compliance. Reviewed clinical records and case documentation to develop findings, recommendations, and quality improvement actions.
- Tracked and trended incidents, grievances, and quality issues to identify risks and improvement opportunities. Developed, requested, and evaluated corrective action plans to mitigate risk and improve compliance outcomes.
- Prepared reports and presented findings to leadership, medical directors, and quality committees. Identified education needs and supported training initiatives to improve quality and regulatory performance. Maintained expertise in healthcare regulations, accreditation standards, and clinical best practices.
Appeals RN
VillageCare
New York, NY (Remote)
04.2022 - 09.2024
- Gather comprehensive information related to eligibility, provider status, benefit coverage, and coordination of benefits to support informed decision-making throughout the appeals process, including prospective, concurrent, and retrospective reviews. Completed 6-8 expedited appeals daily and 30+ standard appeals monthly.
- Interpret and analyze written and verbal instructions, medical records, and clinical documentation to develop clear, evidence-based clinical arguments also founded in policy and regulatory guidelines
- Represent the Plan during Administrative Law appeal hearings.
Nurse Care Manager
VillageCare
New York, NY (Remote)
03.2018 - 04.2022
- Coordinated and evaluated person-centered care plans with internal and external providers, assessed healthcare needs, and monitored plan effectiveness and member progress to achieve desired outcomes.
- Managed a monthly caseload of 140–160 members while maintaining 95%+ compliance with monthly contacts, interdisciplinary coordination, and care plan development; processed member requests in accordance with regulatory guidelines.
Complex Care Manager
Emblem Health
New York, NY
06.2017 - 03.2018
- Managed a daily caseload of 25–40 members transitioning from inpatient discharge, coordinating referrals, post-acute services, and durable medical equipment to support safe continuity of care.
- Assessed, planned, implemented, coordinated, monitored, and evaluated care options and services to optimize health outcomes, developing patient-centered care plans that promoted quality and efficient care delivery.
Utilization Management RN
Guildnet
New York, NY
08.2016 - 06.2017
- Conducted prior authorization reviews for services requiring notification, assessing 10+ cases daily to determine medical necessity, benefit eligibility, and coverage for services and durable medical equipment in compliance with health plan policies and New York State Medicaid guidelines.
- Applied clinical judgment and regulatory criteria to support accurate, timely determinations and appropriate utilization of healthcare services.
- Contributed to audits and quality improvement initiatives by identifying process gaps, supporting compliance efforts, and recommending solutions to improve operational efficiency and review accuracy.
Nurse Case Manager
Guildnet
White Plains, NY
06.2013 - 08.2016
- Managed an average caseload of 120 members while maintaining 95%+ monthly member contact compliance.
- Developed and updated person-centered care plans, collaborated with interdisciplinary teams to identify member needs and goals, prioritized care interventions, and coordinated support services to promote continuity of care and positive health outcomes.
RN Case Manager
Bergen Care Home Health Agency
Bergen, NJ
04.2012 - 05.2013
- Managed 40–60 home care patients through daily visits in Newark, NJ. Administered oral, IV, and IM medications. Completed wound care and various nursing treatments, and monitored patient response. Maintained accurate clinical documentation in OASIS assessment tool.
- Coordinated referrals, interdisciplinary care, and team communication. Educated patients and families on care plan adherence. Served as liaison between patients, families, and providers to support timely care.
Education
MSN Nursing Leadership And Urban Policy -
CUNY Hunter College
New York, NY05.2023
BSN -
New Jersey City University
Jersey City08.2010
Skills
- Interqual, E-Care, CaseTracker
- MS Office
- Managed Care
- Utilization Management
- Quality Management
- Excellent communication
- Organizational skills
- Critical thinking
- Treatment coordination
- Interdisciplinary collaboration
Certification
CCM - Certified Case Manager
Timeline
Clinical Quality-of-Care Nurse
VillageCare
09.2024 - Current
Appeals RN
VillageCare
04.2022 - 09.2024
Nurse Care Manager
VillageCare
03.2018 - 04.2022
Complex Care Manager
Emblem Health
06.2017 - 03.2018
Utilization Management RN
Guildnet
08.2016 - 06.2017
Nurse Case Manager
Guildnet
06.2013 - 08.2016
RN Case Manager
Bergen Care Home Health Agency
04.2012 - 05.2013
MSN Nursing Leadership And Urban Policy -
CUNY Hunter College
BSN -
New Jersey City University