Diane Daugherty
Land O’ Lakes,FL
Summary
Experienced Professional Nurse Manager with diverse health care industry expertise, 20+ years, within the clinical side of payer, vendor, and provider organizations. Proven abilities in developing and implementing policies, procedures, and programs essential to successfully meeting and exceeding organizational goals in the provision of quality and cost-effective care.
Dedicated Insurance professional with a history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Manager – Clinical and Vocational Team
United Health Care – Financial Protection Services
04.2022 - 11.2025
- Provided leadership, coaching, and development to a team of licensed professionals
- Led team in updating our policies and procedures
- Ensured timely distribution of claims to team members and monitored for quality and adherence to turnaround times
- Collaborated with leadership to implement changes to our disability and integrated care processes to involve our nurses in a focused clinical approach to case management referrals
Manager FMLA, Accommodation, and Vocational
United Health Care – Financial Protection Services
11.2024 - Current
- Providing leadership, coaching, and development for 20 Team Members
- Collaborating with our Customer Experience Team to resolve challenges for Employers and Employees
- Oversight of large block of claims ensuring appropriate caseloads for team members, compliance with the Department of Labor FMLA Regulations and with ADA, and high-quality customer service through the monitoring and implementation of performance
- Participating in finalist presentations for brokers and key accounts to provide an overview of FMLA and Accommodation Services
Sr. Clinical Consultant
United Health Care – Financial Protection Services
04.2020 - 04.2022
- Provide clinical consultative services to Claim Teams across all lines of business
- Complete high standard clinical reviews via utilization of my broad medical knowledge base concordantly with the application of policy/contract requirements
- Communicate effectively with providers via correspondence to clarify and resolve clinical claim issues
- Process Improvement Committee
- Vendor relations – assisted in the resolution of record retrieval issues for new vendor acting as a liaison with the vendor and claim teams
- Acting as clinical lead for integration efforts between Financial Protection Services and Optum
- Assumed the responsibilities of Clinical Team Lead January of 2022 and in this role I maintained good working relationships with the Clinical Consultants and have also developed strong peer relationships with Claim Team Leads and Managers
Nurse Consultant
Brown & Brown
10.2018 - 04.2020
- Acted as a trusted advisor providing clarity to complex clinical issues
- Completed high standard clinical reviews via utilization of my broad medical knowledge base concordantly with the application of policy/contract requirements
- Communicated effectively with providers to clarify and resolve clinical claim issues
Manager, Behavioral Health Care Management
Gateway Health Plan
05.2016 - 04.2018
- Provided strategic guidance to CM/UM team members, stimulating discussion of complex business requirements for the development of work-flow diagrams and process re-design.
- Led team in meeting and exceeding Health Plan performance guarantees and agreed service levels by 40%.
Director, Operations
Tri Rivers Assessment Services
01.2010 - 05.2016
- Drove resolution of complex business and claim issues via provision of clinical consultations with Client.
- Developed new business and client relationships resulting in a 25% increase in revenue generated.
- Managed departmental caseload volumes for Workers’ Compensation, Disability, Managed Care Claims
- Conducted regular performance reviews to assess team progress, providing constructive feedback and guidance for continuous improvement.
Sr. Nurse Case Manager
Cigna Group Insurance
12.2002 - 12.2009
- Actively participated in Client and C-level executive presentations
- Developed a clinical topic and presented it at a National Conference
- Evaluated staff from a Quality perspective providing clinical guidance and coaching with success demonstrated by a 15% rate of staff promotions into leadership roles
- Provided clinical consultation for claim specialists and vocational resources in team conferences and on an individual basis
- Performed detailed clinical analysis of medical data and outreach to treating providers, claimants and employers for assessment of clinical status, functional abilities, and return to work plan
Education
Bachelor of Science - Health Arts
University of St. Francis
Joliet, IL2001
Skills
- Root cause identification and analysis
- Corrective action plan development/implementation
- Verbal and written communication
- Deep knowledge of Medicare, Medicaid, Financial Protection, Disability, and Workers’ Compensation insurance
- Process improvement, solution development, and implementation
- Data analytics and reporting
- Cross-functional teamwork
- Work prioritization
- Regulatory compliance
- Multitasking
- Attention to detail
- Adaptability and flexibility
- Customer relationship management
Accomplishments
- Collaborated with team of [Number] in the development of [Project name].
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Supervised team of [Number] staff members.
- Achieved [Result] by completing [Task] with accuracy and efficiency.
Certification
Certified Leave Management Specialist
Timeline
Manager FMLA, Accommodation, and Vocational
United Health Care – Financial Protection Services
11.2024 - Current
Manager – Clinical and Vocational Team
United Health Care – Financial Protection Services
04.2022 - 11.2025
Sr. Clinical Consultant
United Health Care – Financial Protection Services
04.2020 - 04.2022
Nurse Consultant
Brown & Brown
10.2018 - 04.2020
Manager, Behavioral Health Care Management
Gateway Health Plan
05.2016 - 04.2018
Director, Operations
Tri Rivers Assessment Services
01.2010 - 05.2016
Sr. Nurse Case Manager
Cigna Group Insurance
12.2002 - 12.2009
Bachelor of Science - Health Arts
University of St. Francis
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