Cathleen Conway
Tampa
Summary
Strategic thinker skilled at analyzing complex claims with expertise in dispute resolution and claims operations. Proven track record in conducting workflow analysis and evidence-based practices. Detail-oriented team player with strong organizational skills.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Clinical Claims Review (CCR) RN
Humana, Inc.
05.2014 - 07.2024
- Serve a key role in training and mentoring a team of nurses and non-clinical associates while ensuring compliance with healthcare policies, procedures, standards, and practices
- Collaborate with Clinical Claims Manager to design and implement updated practices and workflows
- Review and process provider disputes using contract terms, regulatory requirements, and medical criteria guidelines
- Resolved complex cases by assessing issues related to claim denials and interacting with medical directors and leadership
- Delivered education and training to new CCR nurses for Florida Medicaid line of business.
RN Clinical Resource Coordinator-Case Manager
Baycare St. Joseph's Hospital North
01.2010 - 05.2014
- Orchestrated utilization reviews for multiple units while guaranteeing efficient allocation of resources
- Developed and deployed individualized care plans cooperating with healthcare teams, patients, and respective families
- Advocated for patients' rights, preferences, and needs for compassionate, patient-centered care
- Enhanced cost-effective care delivery by engaging in interdisciplinary rounds daily while collaborating with physicians and healthcare teams
- Engaged in hospital inauguration to showcase state-of-the-art facilities and foster community engagement.
RN Case Manager
H. Lee Moffitt Cancer Center & Research Institute
05.2005 - 01.2010
- Managed utilization review processes for patients in the Thoracic and Sarcoma Divisions
- Involved in weekly tumor board meetings for the Thoracic and Sarcoma Divisions and contributed to collaborative treatment planning
- Counseled patients and families attending Thoracic and Sarcoma Clinics regarding financial and insurance concerns and facilitated the transfer of medical records and pathology slides
- Ensured the best possible clinical outcomes and resource utilization through close coordination with interdisciplinary team members and multiple hospital departments.
RN Case Manager
Northside Hospital and Heart Institute
RN Level III Neonatal ICU
West Boca Medical Center
Assessor Nurse
Coordinated Care Management Corporation
RN/Relief Charge Nurse/Preceptor Level III Neonatal ICU
Children's Hospital of Buffalo
Education
Bachelor of Science in Nursing -
Niagara University - College of Nursing
Lewiston, NYSkills
- Customer Relationship Management (CRM)
- Coaching & Mentoring
- Multidisciplinary Approach
- Cultural Competency
- Critical Thinking
- Utilization Review
Certification
- Registered Nurse State of Florida/Multi-State Compact License, Florida Department of Health, expires 04/2026
- BLS Certified, expires 03/2025
Timeline
Clinical Claims Review (CCR) RN
Humana, Inc.
05.2014 - 07.2024
RN Clinical Resource Coordinator-Case Manager
Baycare St. Joseph's Hospital North
01.2010 - 05.2014
RN Case Manager
H. Lee Moffitt Cancer Center & Research Institute
05.2005 - 01.2010
RN Case Manager
Northside Hospital and Heart Institute
RN Level III Neonatal ICU
West Boca Medical Center
Assessor Nurse
Coordinated Care Management Corporation
RN/Relief Charge Nurse/Preceptor Level III Neonatal ICU
Children's Hospital of Buffalo
Bachelor of Science in Nursing -
Niagara University - College of Nursing
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