Summary
Overview
Work History
Education
Skills
Timeline
Generic

Diane Wilt

Aldan,PA

Summary

Dynamic Clinical Care Reviewer at AmeriHealth Caritas, adept at enhancing document accuracy and confidentiality. Proven ability to streamline processes, reducing review turnaround time. Skilled in effective communication and detail-oriented analysis, contributing to a robust knowledge base for efficient problem-solving. Committed to delivering high-quality service in fast-paced environments.

Overview

20
20
years of professional experience

Work History

Clinical Care Reviewer

AmeriHealth Caritas Family of Companies
07.2018 - Current
  • Maintained strong attention to detail while reviewing numerous documents daily, ensuring consistent quality and accuracy.
  • Maintained strict confidentiality with sensitive client information, adhering to industry standards and company policies.
  • Reduced turnaround time for reviews by effectively prioritizing tasks and managing deadlines.
  • Contributed to the development of a knowledge base for common issues encountered during reviews, streamlining future problem-solving efforts.

RN Central Intake Manager

HCR ManorCare
06.2017 - 06.2018

Evaluates the inquiry while focusing on the severity of the illness and integrity of service to facilitate the patients smooth transition to the nursing center.

Works with Relay Clearance , Navinet and Interqual system.

Processes inquires received either electronically or via fax, at a minimum rate of 5-15 inquires per day

Obtains accurate information from physicians, patient and/or responsible party

Focused on converting inquires to admissions

Addresses and seeks to work collaboratively with center to resolve customer service issues with family and referral services

Direct Authorization Office/Corporate Case Manager

HCR ManorCare
09.2013 - 06.2017
  • Resolved complex corporate disputes with effective negotiation skills, resulting in favorable settlements.
  • Served as a reliable point-of-contact for clients, providing timely updates on case status and addressing concerns with professionalism and care.
  • Assisted clients in navigating legal processes, ensuring full understanding of their rights and responsibilities.
  • Conducted thorough investigations of corporate complaints, identifying root causes and recommending corrective actions.

Registered Nurse

Pennsylvania Hospital
01.2006 - 07.2008
  • 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.

Education

Nursing

Delaware County Community College
Media, PA
05-2005

Skills

  • Proofreading
  • Effective email communication
  • Detail-oriented approach
  • Adaptability to change

Timeline

Clinical Care Reviewer

AmeriHealth Caritas Family of Companies
07.2018 - Current

RN Central Intake Manager

HCR ManorCare
06.2017 - 06.2018

Direct Authorization Office/Corporate Case Manager

HCR ManorCare
09.2013 - 06.2017

Registered Nurse

Pennsylvania Hospital
01.2006 - 07.2008

Nursing

Delaware County Community College
Diane Wilt