Deanne DeBenedet
Lutz,FL
Summary
Seasoned Nurse Consultant a strong, dependable, and self-motivated professional with proven leadership, communication, and critical-thinking abilities, combined with specialized knowledge of appeals processes and a consistent track record of exceeding expectations.
Overview
2
2
years of post-secondary education
20
20
years of professional experience
Work History
Appeals Nurse Consultant
Aetna/ CVS Health
Tampa, FL
10.2016 - Current
- Review medical records and supporting documentation to identify relevant clinical information and apply appropriate guidelines and criteria.
- Assess clinical review findings and prepare precise nurse summaries for Medical Director review.
- Effectively and efficiently navigate multiple computer systems and applications to ensure cases are processed accurately and efficiently.
- Work independently while also contributing to team collaboration and maintaining and exceeding productivity while working virtually.
- Maintain and exceeding quality standards while working in a fast-paced, detail-oriented role requiring extended computer use and extensive documentation.
- Served as a preceptor and subject-matter resource for new hires, providing comprehensive training, mentorship, and guidance to support successful onboarding and adherence to departmental processes and standards.
Utilization Management Nurse Consultant
Aetna
Tampa, FL
11.2008 - 10.2016
- Evaluated patient care plans to ensure compliance with clinical guidelines, regulatory requirements, and established standards of care.
- Collaborated with multidisciplinary healthcare teams to coordinate member services, facilitate continuity of care, and support effective discharge planning.
- Analyzed utilization data to identify trends, opportunities for improvement, and potential barriers to appropriate care.
- Reviewed medical records and patient charts to determine medical necessity and appropriateness of requested services.
- Conducted concurrent and retrospective utilization reviews in accordance with established clinical and regulatory guidelines.
- Partnered with Medical Directors by preparing comprehensive clinical summaries and documentation to support final medical necessity determinations.
- Served as a preceptor and resource for new hires, providing training, guidance, and support to promote successful onboarding and adherence to department processes.
- Independently managed a high-volume caseload while consistently meeting strict turnaround times and maintaining accuracy, quality, and compliance.
Disease Management Nurse
Aetna
Tampa, Florida
01.2007 - 11.2008
- Conduct comprehensive assessments of members with chronic and complex health conditions to identify clinical needs, risks, and barriers to care.
- Develop and implement individualized care management plans based on assessment findings, evidence-based guidelines, and member goals.
- Provide disease-specific education and coaching to promote self-management, medication adherence, healthy lifestyle choices, and improved health outcomes.
- Monitor members’ clinical status and progress through telephonic and/or virtual outreach, identifying changes that may require intervention or escalation.
- Facilitate referrals to appropriate community resources, specialists, and support services based on individual member needs.
- Reinforce preventive care recommendations, including screenings, immunizations, and routine follow-up appointments.
- Document assessments, interventions, member interactions, and outcomes accurately and in accordance with organizational and regulatory requirements.
Education
Bachelor of Science - Nursing
Florida Atlantic University
Boca Raton, FL 05.1997 - 05.1999
Skills
- Strong leadership
- Takes initiative
- Subject-matter expert MPO appeal
- Critical thinking
- High performance
- Proven effective communication skills
- Self-motivated
Timeline
Appeals Nurse Consultant
Aetna/ CVS Health
10.2016 - Current
Utilization Management Nurse Consultant
Aetna
11.2008 - 10.2016
Disease Management Nurse
Aetna
01.2007 - 11.2008
Bachelor of Science - Nursing
Florida Atlantic University
05.1997 - 05.1999