Work Type
Full TimeConsultingLocation Preference
On-SiteHybridLocation: New City, NYMontvale, NJ
Open to relocation: No
Elizabeth Bramman
New City,NY
Work Preference
Summary
Highly knowledgeable Certified Case Manager (CCM) with wealth of acute hospital experience and expertise in case management and utilization review. Poised to contribute to team success and achieve positive results. Ready to tackle new challenges and advance organizational objectives with dedication and enthusiasm.
Overview
1
1
Certification
19
19
years of professional experience
Work History
RN Care Manager
Montefiore Nyack Hospital
Nyack, NY
12.2023 - Current
- Participate in daily multi-disciplinary rounds on various assigned unit caseloads to ensure plan of care and services provided are patient focused, high quality, efficient, cost effective, and without delay while evaluating care provided against benchmark length of stay in order to streamline patient discharges.
- Initiate early assessment and identification of patients' needs for rehabilitation facility, home care, durable medical equipment (DME) and disease specific management, and facilitate arrangement of necessary services and/or DME prior to discharge date.
- Advocated for patients by identifying insurance coverage, communicating care preferences to practitioners, and verifying interventions meet patients' treatment goals, as well as supporting optimal patient outcomes.
- Provide emotional support to patients, and their caregivers, who are coping with chronic illness or end-of-life decisions, fostering resilience during difficult times.
- Managed complex cases with multiple comorbidities through close monitoring and coordination of diverse healthcare services, facilitating comprehensive patient care.
- Provide emotional support to patients coping with chronic illness or end-of-life decisions, fostering resilience during difficult times.
- Educate patients and families on available community resources, facilitating access to necessary support services.
- Review medical charts to determine medical necessity, appropriate level of care, and appropriateness of continued stay in order to avoid adverse financial consequences to both patient and hospital.
RN Care Coordinator, Utilization Manager
Hackensack University Medical Center
04.2015 - 03.2024
- Full time Care Coordinator and Utilization Manager 04/2015 through 02/2020, Per Diem Care Coordinator 05/2020 to 03/2024
- Coordinated case management and utilization management across all areas of acute care setting, ensuring alignment with patient needs and organizational goals
- Reviewed medical charts to determine medical necessity, level of care, and appropriateness of continued stay for patients' admissions while utilizing Milliman Criteria
- Participated in daily multi-disciplinary rounds to ensure plan of care and services provided are patient focused, high quality, efficient, and cost effective while evaluating care provided against benchmark length of stay
- Initiated assessments to identify patients' needs for rehabilitation, home care, DME, and disease-specific management, facilitating timely arrangements for services prior to discharge
- Advocated for patients by identifying insurance coverage, communicating care preferences to practitioners and verifying interventions met patients' treatment goals
- Liaised between patients and physicians to ensure patient comprehension of treatment plans
- Trained and mentored new employees on best practices and hospital policies, fostering a culture of compliance and quality care
Nurse Medical Management Senior, East Region
Anthem, Inc.
12.2022 - 12.2023
- Trained new and transfer employees on company policies and procedures
- Provided coverage for, and assistance to, the team leader, as needed, to ensure continuity of daily team operations and processes.
- Administered patient care and monitored vital signs, ensuring optimal health outcomes.
- Educated patients on disease management and preventative care strategies, enhancing overall health literacy.
- Collaborated with interdisciplinary teams to develop comprehensive treatment plans for diverse patient populations.
Nurse Medical Management II, East Region
Anthem, Inc.
03.2020 - 12.2022
- Conduct pre-certification, inpatient, retrospective, and out of network reviews for appropriateness of treatment setting to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts
- Ensure member access to medically necessary, quality healthcare in a cost effective setting according to contract
- Consulted with clinical reviewers and medical directors to ensure delivery of medically appropriate, high quality, cost effective care throughout medical management process
- Collaborated with providers to assess members’ needs for early identification and proactive planning of discharge
- Facilitate member care transition through the healthcare continuum and refer to medical director as required
- Correctly interpret and apply appropriate regulatory requirements and standards
Registered Nurse
Hackensack University Medical Center
09.2011 - 04.2015
- Provided direct patient care on the observation unit with focus on safe, high-quality, efficient, compassionate care
- Worked in conjunction with Case Management and Social Services to facilitate safe patient discharges, monitor length of stay and clarify appropriateness of patient testing
- Facilitated multi-disciplinary rounds to establish care plans, review test results, address delays, and streamline patient discharges
- Educated unit staff on practice and documentation requirements for the Joint Commission Disease Specific Care Recertification in 2013 for Stroke
- Led monthly RN Unit Based Council meetings to address unit issues, coordinate charity projects, and organize staff celebrations
- Trained and mentored new RNs on best practices, hospital policies and standards of care
Unit Clerk
Hackensack University Medical Center
03.2008 - 09.2011
Education
Bachelor of Science - Nursing
Dominican College
Orangeburg, NY01-2011
Bachelor of Arts - Computer Science
Pace University
Pleasantville, NY01-2005
Associate of Applied Science - Business Office Technologies
Rockland Community College
Suffern, NY01-1998
Skills
- Certified Case Manager (CCM)
- PRI Certified
- Discharge planning
- Acute Care Hospital
- Utilization Review
- Milliman and Interqual criteria proficiency
- EPIC EMR proficiency
- Disease processes and treatments
- HIPAA documentation
- Critical thinking
- Team collaboration
- Clinical mentorship / Preceptor
Certification
Certified Case Manager, CCMC, 09/2019
Timeline
RN Care Manager
Montefiore Nyack Hospital
12.2023 - Current
Nurse Medical Management Senior, East Region
Anthem, Inc.
12.2022 - 12.2023
Nurse Medical Management II, East Region
Anthem, Inc.
03.2020 - 12.2022
RN Care Coordinator, Utilization Manager
Hackensack University Medical Center
04.2015 - 03.2024
Registered Nurse
Hackensack University Medical Center
09.2011 - 04.2015
Unit Clerk
Hackensack University Medical Center
03.2008 - 09.2011
Bachelor of Science - Nursing
Dominican College
Bachelor of Arts - Computer Science
Pace University
Associate of Applied Science - Business Office Technologies
Rockland Community College