Cassandra Rodriguez
Aurora,IL
Summary
Experienced leader with 14 years of nursing experience. Adept at guiding teams, managing complex projects, and achieving strategic objectives. Demonstrates strong ability to develop efficient processes, ensuring high standards and aligning efforts with organizational goals. Recognized for collaborative approach and unwavering commitment to excellence.
Overview
15
15
years of professional experience
Work History
Workers Compensation Medical Claims Unit Manager
Travelers Insurance
04.2018 - Current
- Manage a team of 11 Medical Nurse Case Managers
- Develop and implement effective training, performance development and succession planning
- Employ proper claim handling techniques to protect the integrity of the company brand and providing consistent service quality and streamlined processes to add value for the customers
- Implement strategies and initiatives to improve file quality, customer service and manage costs
- Successfully leverage data, management information and technology to identify and make the most of opportunities to support business strategies and improve results
- Formulated budgets based on projected needs while monitoring expenses closely against allocated funds
- Led recruitment efforts for new hires while overseeing onboarding activities including orientation programs
- Managed pharmacy initiatives with a focus on pharmacy paper bills identifying trends and partnering with product on implementation of strategies to drive optimal results
- Managed Provider Network Penetration for Workers Compensation
Workers Compensation Medical Team Lead
Travelers Insurance
11.2016 - 04.2018
Workers Compensation Medical Case Manager
Travelers Insurance
09.2014 - 11.2016
Director of Nursing
Walnut Grove Village
03.2014 - 08.2014
- Managed Nursing Department consisting of 75 nursing staff members in a 109-bed skilled nursing facility
- Managed clinical operations and delegated appropriate tasks to nursing staff
- Oversight of Managed Care Cases (BCBS, Aetna, Humana, United Health) updating case managers with skilled need of residents to maintain coverage
- Review hospital referrals / Determine skilled nursing coverage for Medicare resident
- Assumed complete responsibility for the facility in the absence of the administrator
- Responsible for retention and recruitment of nursing staff
- Performed general management functions such as disciplining and evaluating employees
- Maintained facility compliance with state and federal regulations / Prepared facility for annual state survey
- Prepared/submitted reports for reportable incidents to Illinois Department of Public Health
- Reviewed/Signed Off on MDS/Care Plans for submission to Medicare
Medicare Nurse Unit Manager
Franciscan Village Mother Theresa Skilled Nursing Facility
09.2010 - 03.2014
- Managed clinical operations of Medicare Unit / Ensured Medicare compliance for authorization on continued need for inpatient stay
- Oversight of Managed Care Cases (BCBS, Aetna, Humana, United Health) updating insurance case managers with skilled need of residents to maintain coverage
- Review hospital referrals / determine skilled nursing coverage for Medicare residents
- Maintain and Manage Nursing processes in Triple Check Process for Medicare billing compliance
- Participated on Interact Program Committee and assisted with implementation of program focusing on reducing/preventing hospital readmissions, while maintaining below national average hospital readmission rate on Medicare unit
- Participated on interdisciplinary QAPI Teams, while collaborating with other health care providers to establish, implement, and maintain quality patient care and services
- Scheduled/delivered continuing education training for nursing staff
- Rotating on call Nursing Supervisor
- Ensured nursing staff complied with established standards, practices, and regulatory requirements by IDPH.
- Developed and managed wound care program
- Oversee skilled nursing documentation and assure correct documentation in place for Medicare compliance
Telemetry Unit Registered Nurse
Loyola University Medical Center
06.2011 - 03.2012
- Provided nursing care on a cardiac telemetry unit with 67 bed capacity
- Assessed patient’s conditions and nursing requirements in areas of cardiac
- Assessed patient’s conditions and nursing requirements in areas of inpatient psych (suicidal ideation/homicidal ideation, ETOH abuse/drug overdose)
- Performed tasks of reviewing data from special equipment to track patients heart rate/rhythm and Spo2
- Heparin Drips, Blood Transfusions, Cardiac IV medication management, IV Diuretics
Medical Case Manager
RSA Medical
02.2010 - 09.2010
- Conducted medical phone interviews for major medical insurance companies
- Gathered medical data from patients and physician offices (ex Physical examinations, diagnostic testing/results, procedures performed etc.)
Education
Bachelors in Science - Nursing
Aurora University
Aurora, IllinoisClaim Case Manager Certification -
Commission For Case Manager Certification (CCMC)
04.2019
Certified Facilitator -
Claim University – Travelers Insurance
Hartford, Connecticut07.2017
Associate in Applied Science - Registered Nurse
Waubonsee Community College
Sugar Grove, Illinois12.2009
Skills
- Leadership
- Registered Nurse
- Certified Case Manager
- Project Management
- Problem Solving Skills
- Adaptability
- Conflict Resolution
- Training and mentoring
- Claim investigation
- Data analytics
- Strong Critical Thinking Skills
- Teamwork
References
References available upon request.
Timeline
Workers Compensation Medical Claims Unit Manager
Travelers Insurance
04.2018 - Current
Workers Compensation Medical Team Lead
Travelers Insurance
11.2016 - 04.2018
Workers Compensation Medical Case Manager
Travelers Insurance
09.2014 - 11.2016
Director of Nursing
Walnut Grove Village
03.2014 - 08.2014
Telemetry Unit Registered Nurse
Loyola University Medical Center
06.2011 - 03.2012
Medicare Nurse Unit Manager
Franciscan Village Mother Theresa Skilled Nursing Facility
09.2010 - 03.2014
Medical Case Manager
RSA Medical
02.2010 - 09.2010
Bachelors in Science - Nursing
Aurora University
Claim Case Manager Certification -
Commission For Case Manager Certification (CCMC)
Certified Facilitator -
Claim University – Travelers Insurance
Associate in Applied Science - Registered Nurse
Waubonsee Community College
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