Candice Mobley
West Monroe,LA
Summary
Dynamic healthcare professional with extensive experience at Louisiana Blue, excelling in team leadership and customer service. Proven track record in enhancing operational efficiency and achieving compliance with NCQA and CMS standards. Skilled in insurance authorizations and critical care nursing, fostering a productive environment while mentoring staff to improve performance and quality outcomes.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Manager Outpatient Medical Management
Louisiana Blue
09.2017 - Current
- Organize and lead outpatient staff meetings and coordinate staffing needs
- Review daily authorization timeliness reports which assist in preparing for NCQA and CMS audits
- Conduct monthly staff performance and quality review
- Review/correct denial letters to ensure accuracy and NCQA/CMS standards are met
- Intake and processing of transplant authorizations
- Conduct annual performance and salary reviews
- Assist with changes/additions to Acuity platform as well as provider portal testing/updates
- Interview new job applicants
- Review and approve timesheets/PTO requests
- Managed and motivated employees to be productive and engaged in work.
- Accomplished multiple tasks within established timeframes.
- Maintained professional and organized environment for employees.
- Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication
- Building new Epic Platform as an analyst for the department
Medical Management Outpatient Nurse Trainer
Vantage Health Plan, Inc.
08.2015 - 09.2017
- Train new Outpatient RNs and Prior Authorization Specialists on all systems and processes utilized in Medical Management
- Perform monthly quality audits on authorizations and incoming calls
- Maintain nurse training manual updates
- Complete daily appeal and ASU reports
- Meet with individual staff to review errors and retrain as necessary
Medical Management RN
Vantage Health Plan, Inc.
06.2014 - 08.2015
- Perform initial intake, review, and notification of authorization decisions via fax/phone for Commercial, Exchange, and Medicare lines of business
- Review clinical information and apply standardized/Interqual criteria to each request
- Compose detailed denial letters based off Medical Director review, NCQA, and CMS guidelines
Registered Nurse
St Francis Medical Center
04.2007 - 05.2014
- Started as a nurse tech prior to obtaining RN in 2008
- Provided exceptional nursing care to acute/chronically ill patients within the Surgical and Neurosurgical Intensive Care Unit
- Assisted physicians with central line placement, endotracheal intubations, and bronchoscopy procedures
- Titration of medications according to orders and patient condition
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Administered/titrated medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Preceptor for entry nurses to the Intensive Care Unit
Education
High School Diploma -
West Ouachita High School
West MonroeNursing
Louisiana State University Alexandria
Alexandria, LA05-2008
Skills
- Customer service
- Team leadership
- Time management
- Decision-making
- Interqual
- Insurance Authorizations
- Precepting
- Critical Care Nursing
Certification
Epic Analyst Certification
Timeline
Manager Outpatient Medical Management
Louisiana Blue
09.2017 - Current
Medical Management Outpatient Nurse Trainer
Vantage Health Plan, Inc.
08.2015 - 09.2017
Medical Management RN
Vantage Health Plan, Inc.
06.2014 - 08.2015
Registered Nurse
St Francis Medical Center
04.2007 - 05.2014
High School Diploma -
West Ouachita High School
Nursing
Louisiana State University Alexandria
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