Denise Schweer
Iowa City,Iowa
Summary
Dynamic Clinical Quality Performance Advisor with a proven track record at Sedgwick Claims Management Services, excelling in claims analysis and compliance oversight. Recognized for enhancing vendor management processes and delivering exceptional training. Adept at data reporting and fostering collaboration, driving significant improvements in operational efficiency and client satisfaction. Strategic Advisor known for high productivity and efficient task completion. Specialize in policy development, stakeholder engagement, and risk management strategies. Excel in communication, adaptability, and problem-solving to navigate complex challenges and drive organizational success.
Overview
1
1
Certification
29
29
years of professional experience
Work History
Clinical Quality Performance Advisor
Sedgwick Claims Management Services
03.2021 - Current
- Guided external vendor partners through complex claims processes and inquiries.
- Oversaw approximately 1,000 open vendor FCM files to ensure compliance.
- Conducted monthly audits of FCM files and facilitated quality meetings with vendors.
- Added new users to One Team Web program and CareLink applications.
- Provided training and mentorship to new advisors on procedures and best practices.
- Analyzed claims data to identify trends and recommend process improvements.
- Resolved client issues promptly while maintaining high customer service standards.
- Collaborated with adjusters to assess risk and determine coverage decisions.
Telephonic Case Manager
Sedgwick Claims Management Services
01.2006 - 01.2021
- Developed proficiency in workers compensation case management.
- Demonstrate efficient and effective management of caseloads.
- Manage multiple clients and jurisdictions licensed in Compact and Many other states.
- Recognized by many clients for outstanding performance.
- Attended Client kick off and worked closely with plant nurses to manage the recovery of injured workers.
- Appointed to act as Supervisor when needed.
- Considered systems expert for my team during software conversion.
- Trained Claims Supervisor in educating claims team on role of TCM and process of collaboration of examiners and RN's.
- Previously completed the SCMS LEAD program. In preparation for advancement in leadership.
Utilization Review Nurse
Cottingham & Butler Insurance
Dubuque, Iowa
01.2004 - 01.2006
- Responsible for telephone triage and review services for patient medical necessity.
- Utilized Milliman and Roberts online system.
Registered Nurse- Internal Medicine
Medical Associates Clinic
Dubuque, Iowa
01.2001 - 01.2004
- Conducted patient interview and assessments.
- Administered injections, performed, and interpreted EKG's and various office diagnostic tests.
- Completed phone triage and patient appointment scheduling.
Staff Nurse-RN
Mercy Medical Center
Dubuque, Iowa
01.1998 - 01.2004
- Gained invaluable experience performing nursing services in Acute Care, Labor and Delivery, Pediatrics, Medical, and Skilled Care departments.
Education
Associate of Science Degree - Nursing
Northeast Iowa Community College
Peosta01.1994
Skills
- Claims analysis and risk assessment
- Compliance oversight
- Data reporting
- Software training
- Vendor management
Certification
- RN Licensure, Maintain RN Licensure in Compact state
- CCM certification
Affiliations
- Active with the National Ski Patrol maintaining certification in Outdoor Emergency Care Certification and snow ski skills.
- Support Scouting America and volunteer when able to assist in the development and skills of our youth.
Timeline
Clinical Quality Performance Advisor
Sedgwick Claims Management Services
03.2021 - Current
Telephonic Case Manager
Sedgwick Claims Management Services
01.2006 - 01.2021
Utilization Review Nurse
Cottingham & Butler Insurance
01.2004 - 01.2006
Registered Nurse- Internal Medicine
Medical Associates Clinic
01.2001 - 01.2004
Staff Nurse-RN
Mercy Medical Center
01.1998 - 01.2004
Associate of Science Degree - Nursing
Northeast Iowa Community College