Gail Adam
Roscoe,PA
Summary
Dynamic Senior Case Nurse Analyst at Cigna with a proven track record in clinical documentation and patient advocacy. Enhanced patient satisfaction through effective communication and timely prior authorizations, while leveraging strong clinical judgment to improve care outcomes. Committed to health promotion and collaboration within interdisciplinary teams to drive quality improvements.
Healthcare professional with solid background in providing high-quality patient care and clinical support. Recognized for collaborative teamwork and results-driven approach, consistently adapting to changing medical needs and priorities. Skilled in patient assessment, medication administration, and maintaining accurate medical records.
Dedicated and compassionate Registered Nurse (RN) with progressive career history in direct patient care, triage and care coordination in fast-paced environment. Proven to remain calm under pressure and skillfully handle difficult patients and high-stress situations. Consistently developing strong relationships with patients and families through empathetic communication, respectful attitude and excellent customer service.
Compassionate Registered Nurse with experience offering comprehensive patient care in outpatient environments. Works well with diverse patient populations and fosters trusting relationships to improve outcomes. Efficiently coordinate with healthcare professionals to advance patient care.
Seasoned nursing professional offering proven clinical knowledge, natural interpersonal strengths and technical abilities. Knowledgeable about EMR charting, medication administration and interdisciplinary collaboration focused on optimizing patient care and support. Quality-focused and efficiency-driven leader.
Overview
34
34
years of professional experience
Work History
Senior Case Nurse Analyst
Cigna
02.2012 - 05.2024
- Enhanced patient care by assessing insurance coverage and obtaining prior authorization for medical procedures.
- Assisted in maintaining compliance with changing regulations and policies by staying up-to-date on industry trends and best practices.
- Improved patient satisfaction by providing clear communication regarding insurance approvals and denials.
- Expedited urgent requests for prior authorization, ensuring timely access to critical medical treatments.
- Provided exceptional customer service to both patients and healthcare professionals, addressing concerns related to the prior authorization process.
- Ensured accurate data entry into electronic health record systems, resulting in improved tracking of prior authorization statuses.
- Tracked performance metrics within the department, identifying areas for improvement and implementing targeted interventions as needed.
- Collaborated with healthcare providers to ensure accurate submission of required documentation for timely authorizations.
- Conducted thorough reviews of medical records, identifying necessary documentation to support prior authorization requests.
- Participated in interdisciplinary team meetings, collaborating with other healthcare professionals to ensure seamless coordination of care for patients requiring prior authorizations.
Disease Management Nurse
Healthways
10.2007 - 06.2012
- Streamlined documentation processes to improve efficiency and ensure accurate patient records.
- Developed targeted nursing interventions based on analysis of data from electronic health records, leading to improved patient outcomes.
- Supported nursing staff through mentorship and guidance in the application of evidence-based practices in disease management.
- Improved patient outcomes by developing and implementing disease management plans tailored to individual needs.
- Implemented a successful telehealth program allowing remote monitoring of high-risk patients leading to reduced emergency room visits.
- Promoted patient self-management by providing education on medications, nutrition, exercise, and lifestyle modifications.
- Reduced hospital readmissions through proactive monitoring of patients with chronic conditions and timely interventions.
- Empowered patients through individualized goal setting sessions resulting in increased adherence to prescribed treatments.
- Strengthened quality assurance measures by participating in performance improvement projects aimed at enhancing clinical outcomes for patients with chronic diseases.
ICU/CCU Registered Nurse
Brownsville Hospital
01.2005 - 04.2006
- Participated in quality improvement initiatives to enhance patient safety and optimize clinical workflows in the CCU setting.
- Assisted physicians with bedside procedures such as central line insertions, intubations, and chest tube placements ensuring patient safety throughout each process.
- Performed advanced life support techniques during emergency situations, resulting in increased patient survival rates.
- Reduced medication errors by diligently following protocols and maintaining clear communication with the healthcare team.
- Facilitated emotional support for patients'' families during difficult times, promoting an empathetic approach to care.
- Maintained accurate documentation of patient conditions, interventions, and responses to treatments.
- Assessed and managed various patient treatments for numerous patient diagnoses from sepsis to acute respiratory distress.
- Administered medications and treatments as ordered by physician.
Hospice Nurse
Three Rivers Hospice And Palliative Care
01.2004 - 12.2004
- Managed pain effectively by closely monitoring symptoms and adjusting medications accordingly.
- Improved patient comfort by providing compassionate end-of-life care and symptom management.
- Coordinated with physicians to adjust medications as needed for optimal palliative care outcomes.
- Offered listening ear to both patients and loved ones to meet emotional and mental, as well as physical needs.
- Promoted a peaceful and supportive environment for patients and their families during the end-of-life transition.
- Advocated for patients'' wishes regarding medical treatment options, respecting cultural beliefs and values throughout the decision-making process.
- Recognized and understood specific stages of dying process, providing comfort-based care during vulnerable times.
- Enhanced family understanding of the hospice process through clear communication and education.
- Taught family members and caregivers various ways to manage patients' pain, how to check for vital signs and proper methods for dressing changes.
Home Care Nurse
Family Home Health Care Services
01.2002 - 01.2004
- Maintained timely documentation of patient progress, facilitating effective communication among the care team members.
- Coordinated services with other healthcare professionals such as physical therapists and social workers, optimizing patient outcomes.
- Educated family members on proper caregiving techniques, promoting a safe and supportive home environment for patients.
- Provided emotional support to patients and families during challenging times, fostering trust and open communication.
- Reduced hospital readmissions by closely monitoring vital signs, medication adherence, and overall wellness.
- Updated and developed care plans to establish goals based on patient's nursing diagnosis.
- Educated and supervised patients and family members regarding prevention strategies, self-care techniques and nursing care needs.
- Administered medications and provided wound care as per physician orders, ensuring accurate treatment delivery.
- Observed patient to chart and report changes in patient condition and adverse reactions to medications and treatments.
Home Health Nurse
Family Home Care
01.1999 - 01.2002
- Developed strong rapport with patients and families, fostering trust and open communication during challenging times.
- Educated patients and families on disease management, medication safety, and at-home healthcare strategies to promote selfcare.
- Documented patient vitals, behaviors, and conditions to communicate concerns to supervising nurse.
- Contributed to the overall success of the home health agency by maintaining high levels of patient satisfaction and positive outcomes.
Albert Gallatin Hospice
Albert Gallatin
04.1992 - 08.1996
- Self-motivated, with a strong sense of personal responsibility.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Proven ability to learn quickly and adapt to new situations.
- Worked well in a team setting, providing support and guidance.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Worked flexible hours across night, weekend, and holiday shifts.
- Demonstrated strong organizational and time management skills while managing multiple projects.
Staff RN
Monongahela Valley Hospital
02.1990 - 03.1992
- Utilized critical thinking skills to make quick decisions in high-pressure situations, prioritizing patient needs and addressing emergent issues promptly.
- Monitored vital signs, lab results, and other indicators to detect changes in patients'' conditions promptly.
- Served as a preceptor for new nurses, sharing knowledge, expertise, and best practices to improve their skills and confidence.
- Participated in unit-based quality improvement initiatives focused on enhancing patient outcomes through process improvements.
Education
Diploma - Nursing
Washington Hospital School of Nursing
Washington, PA01-1988
Skills
- Clinical documentation
- Clinical judgment
- Licensed RN
- Health promotion
- Licensed by PA nursing board
- Nursing assessments
- RN case management
- Electronic health records management
- Nasogastric tube insertion
- Catheter maintenance
- Patient monitoring
Timeline
Senior Case Nurse Analyst
Cigna
02.2012 - 05.2024
Disease Management Nurse
Healthways
10.2007 - 06.2012
ICU/CCU Registered Nurse
Brownsville Hospital
01.2005 - 04.2006
Hospice Nurse
Three Rivers Hospice And Palliative Care
01.2004 - 12.2004
Home Care Nurse
Family Home Health Care Services
01.2002 - 01.2004
Home Health Nurse
Family Home Care
01.1999 - 01.2002
Albert Gallatin Hospice
Albert Gallatin
04.1992 - 08.1996
Staff RN
Monongahela Valley Hospital
02.1990 - 03.1992
Diploma - Nursing
Washington Hospital School of Nursing
Similar Profiles
Micheal D. OvuedeMicheal D. Ovuede
Sr. GRC Consultant at CignaSr. GRC Consultant at Cigna
KACIE M. FORDKACIE M. FORD
National Stars and Risk Adjustment Director at CignaNational Stars and Risk Adjustment Director at Cigna
JAMIE LAVALLEYJAMIE LAVALLEY
Account Installation Senior Representative at CignaAccount Installation Senior Representative at Cigna
Kristina Nestor WalkerKristina Nestor Walker
HCC Coder and Quality Review Audit Analyst at CignaHCC Coder and Quality Review Audit Analyst at Cigna
Brian WilliamsonBrian Williamson
Fueler at Velocity Rail SolutionsFueler at Velocity Rail Solutions