Summary
Overview
Work History
Education
Skills
Software
Timeline
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Cindy Ramos

Nurse Care Coordinator
Franklin,TN - Remote

Summary

Dedicated and reliable nurse with over 6 years of experience in Case Management, with history of meeting company goals utilizing consistent and organized practices. Excellent attention to detail and organizational skills. Offering excellent communication and good judgment.

Overview

6
6
years of professional experience
1
1
year of post-secondary education

Work History

Nurse Care Coordinator Telephonic

Evicore
Franklin, TN
12.2019 - Current
  • Review of clinical information submitted by providers to appropriate criteria and make decision to issue a review determination or to refer to physician review if criteria are not met.
  • Investigation of unusual utilization patterns, assist in preparing, maintaining, and disseminating utilization review reports and communications.
  • Support processes that promote cost effective utilization and quality patient outcomes.
  • Communication with providers and members regarding Medical Director determinations and authorizations.

Nurse Care Coordinator BCBS Michigan

Evicore
Franklin, TN
11.2016 - 12.2019
  • Reviewed clinical information submitted by providers to appropriate criteria and standards and makes decision to issue a review determination or to refer to physician review if criteria are not met.
  • Supported processes that promoted cost effective utilization and quality patient outcomes.
  • Attended in-person meetings with members, staff, and physicians at assigned skilled nursing facilities to determine and evaluate level of appropriate care, medical necessity, and development of effective long-term care strategies.
  • Drove skilled nursing staff and physicians to determine goals for level of care to promote length-of-stay management and coordinate post-acute transitions.

Education

Associate of Applied Science - LPN

Alpena Community College
Alpena, MI
08.2013 - 05.2014

Associate of Applied Science - General Sciences

Alpena Community College
Alpena, MI
08.2016 - 12.2016

Skills

    Seasoned in medical clinical procedures

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Software

PAC Manager

EP Platform

Excel

Word

Timeline

Nurse Care Coordinator Telephonic

Evicore
12.2019 - Current

Nurse Care Coordinator BCBS Michigan

Evicore
11.2016 - 12.2019

Associate of Applied Science - General Sciences

Alpena Community College
08.2016 - 12.2016

Associate of Applied Science - LPN

Alpena Community College
08.2013 - 05.2014

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Cindy RamosNurse Care Coordinator