Gineen Shawah BSN, CCM
Lincoln Park
Summary
Dynamic Care Manager with extensive experience with Atlantic Health System, excelling in utilization review and denials management. Proven ability to enhance patient outcomes through effective communication and compliance with Medicare guidelines. Skilled in EPIC and MCG, with a strong focus on optimizing discharge processes and staff training for improved service delivery.
Overview
20
20
years of professional experience
2
2
Certifications
Work History
Utilization Review Registered Nurse (per-diem)
Atlantic Health System
Morristown
04.2025 - Current
- Perform admission, concurrent, and retrospective reviews to ensure medical necessity and appropriate care levels using MCG and CMS guidelines.
- Evaluate medical records for adherence to insurance compliance standards.
- Conduct inpatient utilization reviews to verify alignment with admission criteria and concurrent review requirements.
Care Manager, Emergency Department
Morristown Medical Center
06.2024 - Current
- Screened all emergency department patients for admission appropriateness using MCG guidelines.
- Organized community resources to enhance client access to services.
- Facilitated communication between clients, families, caregivers, social services and other agencies to ensure client needs were met.
- Conducted case management assessments to confirm acute care eligibility for patient admissions.
- Developed discharge plans for patients in both inpatient and observation status.
- Collaborated with Nurse Navigators and Social Work to facilitate timely transitions from admission to discharge.
Assistant Manager of Case Management
Morristown Medical Center, Atlantic Health System
Morristown
09.2022 - 06.2024
- Collaborated with leadership and unit managers to optimize discharge processes and minimize length of stay.
- Developed and executed staff training programs to improve service delivery.
- Managed scheduling and resource allocation to enhance operational efficiency.
- Analyzed patient feedback to strengthen service quality and patient experience.
- Ensured compliance with healthcare regulations and safety standards in daily operations.
- Participated in recruitment efforts through candidate interviews and evaluations.
- Provided guidance to junior staff on tasks, projects, and objectives.
Inpatient Care Manager (RN)
Chilton Medical Center, Atlantic Health System
Pompton Plains
02.2019 - 09.2022
- Performs utilization reviews in accordance with state and federal regulations using MCG Guidelines
- Collaborate with interdisciplinary team to work towards reducing readmissions
- Assess patient needs and developed individualized care strategies for optimal outcomes.
- Facilitate communication between patients, families, and healthcare providers for effective collaboration.
- Monitored patient progress and adjusted care plans based on evolving health conditions.
Inpatient Care Manager (RN)
Atlantic Rehab Institute, Atlantic Health System
Morristown
04.2018 - 02.2019
- Coordinated interdisciplinary teams to ensure patients achieved goals for next level of care.
- Collaborated with insurance companies to secure approved days based on patient needs.
- Ensured compliance of patient stays and care plans with Medicare guidelines.
Billing Compliance, RN
Atlantic Health System
Morristown
08.2014 - 04.2018
- Audited medical records and billing documents for compliance and accuracy.
- Entered billing charges based on audit findings to ensure proper revenue capture.
- Developed educational programs for clinical departments to enhance documentation practices and minimize lost revenue.
Appeals/Utilization Review Nurse
Executive Health Resources
Newtown Square
10.2013 - 06.2014
- Reviewed Medicare inpatient medical necessity denials and crafted persuasive appeal letters.
- Analyzed medical records to assess appropriateness of inpatient medical necessity.
- Contributed to pilot team developing a Hospice Medicare appeals product, enhancing operational framework.
Home Health and Hospice RN
Visiting Health Services of NJ
Totowa
04.2012 - 10.2013
- Delivered compassionate care to terminally ill patients in home settings.
- Educated families on symptom control, pain management, and disease progression.
- Assessed patient needs, developing and implementing tailored care plans.
- Ensured compliance with Medicare and Medicaid regulations through proficient Oasis-C documentation.
RN Staff/Charge Nurse (Medical Intensive Care Unit)
Clara Maas Medical Center
Belleville
03.2006 - 12.2010
- Administered medications and treatments according to established protocols and care plans.
- Collaborated with interdisciplinary teams to optimize patient care and outcomes.
- Trained new nursing staff on procedures, policies, and best practices.
- Utilized critical thinking skills to assess clinical situations quickly and accurately.
Education
Bachelor of Science - Nursing
Grand Canyon University
Phoenix, AZ10.2017
Associate Degree - Nursing
County College of Morris
Randolph, NJ12.2005
Skills
- Certified case manager
- Utilization review
- Denials management
- Billing compliance and auditing
- Management skills
- EPIC and MCG proficiency
- Medicare and Medicaid knowledge
Certification
Registered Professional Nurse (New Jersey Issued, pursuing multi-state,License # 26NR12437600)
Timeline
Utilization Review Registered Nurse (per-diem)
Atlantic Health System
04.2025 - Current
Care Manager, Emergency Department
Morristown Medical Center
06.2024 - Current
Assistant Manager of Case Management
Morristown Medical Center, Atlantic Health System
09.2022 - 06.2024
Inpatient Care Manager (RN)
Chilton Medical Center, Atlantic Health System
02.2019 - 09.2022
Inpatient Care Manager (RN)
Atlantic Rehab Institute, Atlantic Health System
04.2018 - 02.2019
Billing Compliance, RN
Atlantic Health System
08.2014 - 04.2018
Appeals/Utilization Review Nurse
Executive Health Resources
10.2013 - 06.2014
Home Health and Hospice RN
Visiting Health Services of NJ
04.2012 - 10.2013
RN Staff/Charge Nurse (Medical Intensive Care Unit)
Clara Maas Medical Center
03.2006 - 12.2010
Bachelor of Science - Nursing
Grand Canyon University
Associate Degree - Nursing
County College of Morris