Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Diane Myerson

Cary,IL

Summary

Expert in healthcare technology with a knack for fostering teamwork and collaboration.

Seasoned nursing professional offering proven clinical knowledge, natural interpersonal strengths and technical abilities.

Experienced with patient care optimization, delivering comprehensive nursing consultancy services to enhance healthcare practices. Utilizes clinical expertise to advise on best practices and improve patient outcomes. Knowledge of regulatory compliance and healthcare standards, ensuring high-quality care and operational efficiency.

Thorough team contributor with strong organizational capabilities. Experienced in handling numerous projects at once while ensuring accuracy. Effective at prioritizing tasks and meeting deadlines.

Overview

32
32
years of professional experience
1
1
Certification

Work History

RN Consultant

AssureCare LLC
11.2022 - 12.2024
  • Streamlined nursing processes by identifying areas for improvement and implementing evidence-based best practices.
  • Mentored new nurses, providing guidance on professional development, clinical expertise, and career advancement opportunities.
  • Expert in Med Compass
  • Knowledgeable of all insurance plans-MA, Medicaid, and Commerical.
  • Familiarly with the development of CM/UM business requirements.

RN Case Manager

Humana Insurance Company
03.2014 - 11.2022
  • Provided emotional support to patients coping with chronic illness or end-of-life decisions, fostering resilience during difficult times.
  • Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
  • Collaborated closely with physicians to develop individualized treatment plans, supporting optimal patient outcomes.
  • Educated patients and families on available community resources, facilitating access to necessary support services.
  • Reduced hospital readmission rates through effective case management and patient education on self-care techniques.
  • Optimized resource utilization by identifying opportunities for cost containment while maintaining quality of care.
  • Mentored new nursing staff, facilitating a faster learning curve and increased overall team efficiency.
  • Participated in quality improvement initiatives aimed at enhancing the delivery of nursing care within the organization.
  • Monitored patient progress closely, adjusting care plans as necessary to meet evolving health requirements.
  • Boosted patient adherence to treatment plans through regular check-ins and motivational interviewing techniques.
  • Conducted comprehensive assessments of patient needs to inform effective care planning.

RN Case Manager and Utilization Review RN

Centegra Hospital
05.2000 - 03.2014
  • Provided emotional support to patients coping with chronic illness or end-of-life decisions, fostering resilience during difficult times.
  • Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
  • Collaborated closely with physicians to develop individualized treatment plans, supporting optimal patient outcomes.
  • Educated patients and families on available community resources, facilitating access to necessary support services.
  • Enhanced patient care by developing comprehensive care plans and coordinating with interdisciplinary healthcare teams.
  • Reduced hospital readmission rates through effective case management and patient education on self-care techniques.
  • Served as a key liaison between patients, families, and healthcare providers, fostering open communication and trust among all parties involved in the care process.
  • Coordinated care conferences with interdisciplinary team members, ensuring all perspectives were considered in the development of comprehensive treatment plans.
  • Advocated for patients'' rights and preferences, working diligently to align care with individual values and goals.
  • Conducted thorough assessments of patients'' needs, enabling more accurate diagnoses and targeted interventions.
  • Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
  • Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
  • Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
  • Submitted cases for criteria failures and helped facilitate resolutions and approvals.
  • Obtained authorizations from multiple insurance carriers for various levels of care.
  • Performed admission reviews based for medical necessity based upon MCG/InterQual specification.
  • Processed and finalized appeals and grievances within agreed-upon turnaround time.
  • Demonstrated high-level attention to detail when reviewing medical records, provider contracts, and other relevant documents during case assessments.
  • Upheld organization''s reputation as a compliant plan sponsor by staying current on all relevant regulations and guidelines governing the appeals and grievances process.
  • Provided exceptional customer service when interacting with individuals involved in each appeal or grievance situation, demonstrating empathy and professionalism at all times.
  • Reduced turnaround times for case resolutions by effectively prioritizing workload based on urgency levels designated by regulatory standards.

Register Nurse NICU

Advocate Lutheran General Hospital
01.1995 - 03.2014
  • Performed accurate documentation of patient assessments, interventions, and outcomes in compliance with regulatory standards.
  • Administered medications via oral, IV, and intramuscular injections and monitored responses.
  • Performed routine wound care and dressing changes on schedule.
  • Promoted a safe and comfortable healing environment by addressing patient concerns promptly and professionally.
  • Remained calm during high-stress, critical situations, demonstrating sustained focus and problem-solving in real-time.
  • Enhanced team efficiency by mentoring new nurses, sharing expertise in neonatal care techniques.
  • Led quality improvement initiatives, analyzing care outcomes and implementing strategies for continuous enhancement.
  • Assisted physicians with diagnostic procedures, ensuring accurate results for prompt treatment decisions.
  • Facilitated parental involvement in newborn care, strengthening family bonds and supporting emotional well-being.
  • Provided emotional support to families during difficult times, offering guidance and resources as needed.
  • Collaborated with interdisciplinary healthcare teams for optimal patient outcomes.

Registered Nurse

Children's Memorial Hospital
06.1993 - 01.1995
  • Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
  • Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
  • Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
  • Enhanced patient satisfaction by providing compassionate, holistic nursing care that addressed physical, emotional, and spiritual needs.
  • Prevented the spread of infections by consistently adhering to strict infection control protocols and educating patients on proper hygiene practices.
  • Collaborated with interdisciplinary teams to develop comprehensive treatment plans for complex patients with multiple comorbidities.
  • Served as a preceptor for nursing students during their clinical rotations, providing valuable real-world experience and guidance to foster professional growth.
  • Participated in ongoing professional development opportunities to stay current on best practices in nursing care and emerging trends in healthcare delivery.
  • Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.

Education

Bachelor of Science - Nursing

Elmhurst College
Elmhurst, IL
05-1993

Skills

  • Clinical judgment
  • Quality improvement
  • Ethical practice
  • Evidence-based practice
  • Clinical leadership
  • Clinical documentation
  • Healthcare technology
  • Teamwork and collaboration
  • Time management
  • Attention to detail
  • Problem-solving abilities
  • Excellent communication

Certification

CCM Certificate

Timeline

RN Consultant

AssureCare LLC
11.2022 - 12.2024

RN Case Manager

Humana Insurance Company
03.2014 - 11.2022

RN Case Manager and Utilization Review RN

Centegra Hospital
05.2000 - 03.2014

Register Nurse NICU

Advocate Lutheran General Hospital
01.1995 - 03.2014

Registered Nurse

Children's Memorial Hospital
06.1993 - 01.1995

Bachelor of Science - Nursing

Elmhurst College

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Diane Myerson