Debra M. Glazier
New Haven,CT
Summary
Meet health needs via communication and advocacy while promoting quality, cost-effective outcomes. Diligent [Desired Position] with solid background in providing administrative support and managing office tasks. Proven track record of streamlining operations and improving efficiency in previous roles. Demonstrated strong organizational and communication skills. Professional with background in administrative support, known for high standards and results-driven approach. History of optimizing office operations and contributing to team success. Reliable and adaptable, consistently meeting changing needs. Skilled in organization, communication, and multitasking. Experienced with administrative support, including scheduling, correspondence, and office management. Utilizes organizational skills to maintain efficient workflows and ensure task completion. Knowledge of communication techniques to facilitate smooth interactions within team and with clients.
Overview
28
28
years of professional experience
Work History
Assistant for Non-profit
The Workplace
03.2033
- Assisted with phone calls to government agencies and businesses to encourage support and implementation of a program to assist disabled and elderly in various communities in CT
- Temporary-Remote
Direct Care Nursing
Various Agencies
01.1996 - 01.2006
- Ensured efficient, coordinated clinic flow; assessed, communicated, addressed patient needs implemented immunization programs for patients with conditions: diabetes, respiratory illnesses, cardiovascular disease; performed school nursing, occupational health, urgent care/university health clinics
- Accomplishment: Managed flu clinics, school, and occupational health sites, and medications Telehealth
RN Research Consultant
Self-Employed
01.1996 - 01.2006
- Conducted research in HIV/AIDS, cancer, Alzheimer’s, renal anomalies, developmental disabilities, and diabetes for area hospitals, universities, “think tanks,” and private agencies
- Researched and co-authored first ever publication for CDC on HIV/AIDs impacting public policy
- Co-authored article on alternative therapies used in the care of HIV patients
- Co-authored papers used to help form criteria for research in medical conditions for clients on disease conditions that included: renal, cardiac, respiratory, neurological, as well as vascular
- Focus was on educating non-medical people on care
RN. Utilization Management
Amalgamated Medical Care Management
12.2023 - 02.2024
- Contractor for Utilization Management - Reviewed medical information to determine medical necessity based on policy for an outside agency providing IVF services for infertile patients
- Temporary
RN, Utilization Management
Medasource
10.2022 - 02.2023
- Contractor for Utilization Management - Reviewed medical information via EMS to determine medical necessity for out-patient physical health
- Developed productive relationships with providers/vendors
- Performed medical ICD10 and CPT coding, reviewed codes, and worked to ensure review accuracy
- Temporary
RN, Utilization Management
Alps Services, Inc.
02.2022 - 07.2022
- Reviewed claims post-service/post-appeal - used EMS System data to determine medical necessity, and analyzed claims for any indications of fraud, waste, and abuse
- Verified eligibility and applied appropriate criteria to deliver the authorization for services
- Temporary
Program RN – Direct Care/Case Management
CRI, Inc.
06.2021 - 02.2022
- Triaged and followed through on medical needs for clients on and off work schedule by phone
- Managed / supported medical needs of individuals with intellectual disabilities & comorbidities
- Evaluated, assessed, developed, and implemented care plans for patients with acute and chronic mental health conditions including drug and alcohol recovery
- Managed patient’s therapeutic program while increasing expense control
- Documented / wrote procedures for staff regarding medications, protocols and care plan needs
- Taught proper procedures to administer/order meds, and call pharmacy to correct/fill orders
- Assessed patient needs via referrals, provided patient education, provider notification, and physician ordered treatment; performed physical exams; administered medications and taught others; ensured services, treatments, therapies, lab work and immunizations for patients
Primary Care/Behavioral Health Case Manager
Elara Caring
08.2020 - 06.2021
- Served as Case Manager and oversaw care and work by more than12 RNs, LPNs, CNAs, and other staff to ensure quality and safe delivery of comprehensive home health care and telephonic triage for patients with behavioral/mental health diagnoses and comorbid conditions
- Managed patient’s entire medical and therapeutic program while increasing expense control
- Evaluated, assessed and developed/implemented plans of care for patients with acute and chronic mental health conditions including drug and alcohol recovery
- Performed additional evaluation and treatment for patient medical comorbidities such as genetic, COPD, cardiovascular, infectious diseases, and diabetes
- Ensured timely documentation and entry of patient information to facilitate the development of the OASIS data set and485 orders of continued accurate patient care
- Performed medical ICD10 and CPT coding, reviewed codes, and worked to ensure review accuracy
- Accomplishment: Selected to receive training in and served as trainer for Major Joints, Pain Management and Spine Surgery protocols
UM / Clinical Review RN
Commonwealth Care Alliance
01.2019 - 01.2020
- Made clinical decisions as a generalist, including home care, using EMS System to review services requiring prior authorization across clinical areas to determine medical necessity
- Ensured accurate documentation of clinical decisions and consistency in applying policy
- Educated patients and office staff and notified them of denials and approvals
- Worked with leadership to ensure policies, regulatory, and contractual requirements were met
- Performed medical ICD10 and CPT coding, reviewed codes, and worked to ensure review accuracy
Utilization Management/Case Management RN
EviCore, Inc.
01.2014 - 01.2019
- Reviewed EMS records and determined coverage for medical necessity per company guidelines
- Trained more than25 staff nurses in conducting reviews for major joint procedures
- Wrote processes for following protocols and set learning tools / guidelines to review claims
- Performed evidence-based, decision support to determine appropriateness of care for patients with musculoskeletal conditions with comorbidities: genetic / cardiovascular disease, diabetes, and mental health conditions to raise cost effectiveness while improving health outcomes
- Performed medical ICD10 and CPT coding, reviewed codes, and worked to ensure review accuracy
Utilization Review/Pre-Service RN
United Health Care
01.2012 - 01.2014
- Determined medical appropriateness of services through reviews and audits, and analyzed claims for indications of fraud, waste, and abuse
- Reviewed member/provider requests and appeals to determine appropriate utilization of benefits and claim resolution
- Reviewed ICD10 and CPT codes and worked to ensure review accuracy
- Documented and provided emails to other departments regarding protocols for reviewing claims for durable medical equipment, endocrine, neurological, and cardiovascular reviews
- Knowledge of Milliman Care Guidelines (MCG) and Medicare/CMS
Disease/Case Management Staff Nurse
McKesson Health Services
01.2011 - 01.2012
- Delivered nursing services and care coordination to high-risk Medicaid patients remotely
- Provided education, counseling and on-demand information to patients enrolled in a condition-specific program
- Conditions included diabetes, behavioral health, ASD, cardiovascular disease, neurological, etc.
- Managed patient’s therapeutic program, via EMS System while increasing expense control
- Developed/coordinated action plans to implement interventions and act as patient advocate and liaison with providers and other agencies by completing/facilitating those interventions
- Accomplishment: Recognized for managing largest case load in department
Field Reviewer/RN Assignments (CT)
Outcomes Health Info. Solutions
01.2008 - 01.2011
- Managed Connecticut staff of ten in doing reviews; ensured projects finished on a timely basis
- Performed chart audits in hospitals, clinics, and MD offices for four HEDIS project seasons
Nurse / Telehealth/Disease Management Nurse
Aetna Insurance Company
01.2006 - 01.2008
- Implemented and performed health coaching to members with chronic and emergency conditions
- Encouraged participant’s motivational level by addressing barriers and assisting with health care needs
- Coordinated triage calls for members with ASD, cardiac, neurological, vascular, endocrine, and respiratory conditions with written documentation sent to members as needed
- Managed the patient’s/individual’s therapeutic program while increasing expense control
- Maintained standard of metrics measures throughout career; consistently received high scores on audits and received consistent awards for member reviews, commendations, and teamwork
- Accomplishment: Recognized with multiple awards for performance excellence and quality service
Education
B.A. - PSYCHOLOGY
Univ. of Mass.
Boston, MAB.A. - ENGLISH LITERATURE
Univ. of Massachusetts
Boston, MAA.S. - NURSING
Northeastern University
Boston, MASkills
- Fast learner
- Time management
- Computer skills
- Attention to detail
- Team collaboration
- Verbal and written communication
- Relationship building
- Data entry
- Problem-solving
- Workload management
- File and record keeping
Certification
Licenses in CT and MA
Affiliations
American Medical Writers Association01-309
Publications
- Glazier, Debra M., and Raymond Glazier, Jr. Understanding Alternative Therapies Often Used to Fight HIV Infection. AIDS Medical Report (July1990), Vol.3, No.7, pp.77-86.
- Glazier, Debra M., and Raymond Glazier, Jr. Guest Column: Alternative Mind and Body Techniques Used to Fight HIV Infection. AIDS Alert (November1989), Vol.4, No.11, pp.185-188.
- Glazier, Debra M., and Raymond Glazier, Jr. Guest Column: Understanding Alternative Therapies Often Used to Fight HIV Infection. AIDS Alert (October1989), Vol.4, No.10, pp.170-173.
- Korda, Holly, Deborah Guiher, Raymond Glazier, Debra Glazier et al. An Annotated Bibliography of Scientific Articles on AIDS for Policymakers. (Washington, D.C.: U.S. Government Printing Office, GPO Pub.#017024-013382,1987).
Training
(AHIP): Health Insurance Basics; (AAACEUs): Utilization Review, Parts1,2a,2B, Criteria (Medcom Trainex): Developing Policy and Procedure Documents, How to Select the Best Healthcare Consultant, Medical Errors, Understanding Managed Care, Nursing Negligence, Introduction to Billing and Coding/ICD9.
Timeline
Assistant for Non-profit
The Workplace
03.2033
RN. Utilization Management
Amalgamated Medical Care Management
12.2023 - 02.2024
RN, Utilization Management
Medasource
10.2022 - 02.2023
RN, Utilization Management
Alps Services, Inc.
02.2022 - 07.2022
Program RN – Direct Care/Case Management
CRI, Inc.
06.2021 - 02.2022
Primary Care/Behavioral Health Case Manager
Elara Caring
08.2020 - 06.2021
UM / Clinical Review RN
Commonwealth Care Alliance
01.2019 - 01.2020
Utilization Management/Case Management RN
EviCore, Inc.
01.2014 - 01.2019
Utilization Review/Pre-Service RN
United Health Care
01.2012 - 01.2014
Disease/Case Management Staff Nurse
McKesson Health Services
01.2011 - 01.2012
Field Reviewer/RN Assignments (CT)
Outcomes Health Info. Solutions
01.2008 - 01.2011
Nurse / Telehealth/Disease Management Nurse
Aetna Insurance Company
01.2006 - 01.2008
Direct Care Nursing
Various Agencies
01.1996 - 01.2006
RN Research Consultant
Self-Employed
01.1996 - 01.2006
B.A. - ENGLISH LITERATURE
Univ. of Massachusetts
A.S. - NURSING
Northeastern University
B.A. - PSYCHOLOGY
Univ. of Mass.
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