ISLE PISZKO
Atlanta,Georgia
Summary
Highly qualified training specialist, nurse medical manager and registered nurse with decades of experience in case and utilization management. Proven abilities in managing multiple cases simultaneously and providing exceptional care coordination to a broad range of acute and chronically ill patients. Strong ability in establishing and maintaining rapport with clients, all members of the medical team (physicians, pharmacists, social workers, health advocates), and third parties such as skilled nursing and rehabilitation facilities. Knowledgeable in Medicare rules.
Overview
27
27
years of professional experience
1
1
Certification
Work History
TRAINING SPECIALIST
ANTHEM HEALTHCARE
Atlanta, GA
10.2016 - 11.2024
- The Training Specialist is responsible for facilitating a variety of performance-based learning events that may include, but are not limited to general associate, management, sales, clinical, technical and operations training
- Training often focuses on more abstract, less concrete soft skills training meant to influence behavior and buy-in from others
- Primary duties may include, but are not limited to: Facilitates learning events that are performance-based in nature
- Delivers synchronous and asynchronous learning events using varied media in virtual and global environments
- Employs rapid course and line of business development methodologies to quickly meet client needs
- Exercises classroom management including learner performance and escalates issues to Performance Solution and client leadership
SENIOR NURSE MEDICAL MANAGER
ANTHEM HEALTHCARE
Atlanta, GA
01.2009 - 10.2016
- As a senior nurse medical manager, my role was to manage care coordination for 30 - 50 inpatient and outpatient medical cases per day
- I would review all pertinent records, including treatment histories and test results in order to ensure compliance with our company's approval guidelines and policies
- I performed extensive research in order to determine coverage, establish demographics, refer members to providers and facilitate necessary hand-offs between other care team members and clients
- I also worked closely with other members of our medical team, including physicians, pharmacists, social workers, health advocates, and case managers in order to provide the appropriate review and handling cases
- I would coordinate with outside parties, specifically skilled nursing facilities, long-term acute care and rehabilitation in order to manage an entire case
- Additionally, I educated members so they better understood their insurance guidelines and policies regarding benefits, referrals, and overall care coordination
- An integral part of the health care coordination team, I participated in daily huddles, as well as comprehensive bi-weekly medical rounds with all members of our team
SENIOR NURSE CASE MANAGER
WELLPOINT (ACQUIRED BY ANTHEM)
Atlanta, GA
10.2006 - 12.2008
- As a senior nurse case manager, I was responsible for medical management and review of inpatient cases in order to determine compliance with plan and policy guidelines
- I reviewed records including treatment histories and test results, in order to ensure compliance with our company's approval guidelines and policies
- I educated clients on insurance policies and benefits, handled their referrals, and managed the overall care coordination
- I provided support to our clients through advice and referred to outside resources
- I set goals for each member and help them to meet those goals
- I also worked closely with other members of our medical team in order to provide appropriate reviews and handling of each case
- I referred clients to other members of our team, e.g
- Disease management, transplant & behavioral health, and coordinated with skilled nursing facilities, long-term acute care and rehabilitation, home health, outpatient therapy centers, genetics, and other providers when appropriate
- I participated in weekly case presentations that provided insight into best practices and ways of best supporting our clients
- I educated clients on their insurance policies and benefits, handled their referrals and managed the overall care coordination process
MEDICAL UNDERWRITER
WELLPOINT (ACQUIRED BY ANTHEM)
Atlanta, GA
10.2005 - 10.2006
- As a medical underwriter, I reviewed and analyzed medical information provided through questionnaires in order to determine pricing strategies for clients' premiums
- As part of my processes, I would perform analysis within guidelines in order to score members based upon their medical history
LEGAL NURSE CONSULTANT
KING & SPALDING, LLP
Atlanta, GA
09.2004 - 08.2005
- As a legal nurse consultant, I was responsible for supporting the attorneys in my office by creating medical fact reports and summaries of medical findings in preparation for trials and arbitration
- As part of my processes, I thoroughly researched clients' medical records, reviewed photos and exhibits, and highlighted specific information in support of our clients
SENIOR NURSE CASE MANAGER, CASE MANAGER, AND UTILIZATION REVIEW NURSE
WELLPOINT (ACQUIRED BY ANTHEM)
Atlanta, GA
09.2001 - 09.2004
- In my roles as a senior nurse case manager, case manager, and utilization review nurse, I was responsible for the medical management and review of inpatient cases in order to determine compliance with plan and policy guidelines
- In order to manage these cases, I reviewed all pertinent records, including treatment histories and test results, in order to ensure compliance with our company's approval guidelines and policies
- I also worked closely with other members of our medical team, including physicians, disease management and behavioral health
- At times I would refer our clients to other members of our team, such as disease management and behavioral health
- I coordinated with skilled nursing facilities, long-term acute care and rehabilitation, home health, outpatient therapy centers and equipment providers to ensure proper handling of each case
- I also participated in weekly case presentations which provided insight into best practices and ways of best supporting our clients
- Additionally, I educated clients on their insurance policies and benefits, handled their referrals, and managed the overall care coordination process
- I provided support to our clients through advice and referred them to outside resources
- I set up goals for each member and worked over time to meet those goals
REGISTERED NURSE - MEDICAL/SURGICAL UNIT
NEWNAN HOSPITAL
Newnan, GA
12.2000 - 08.2001
- As a medical-surgical nurse, I was responsible for direct patient care of a general medical patient population
- In this role, I assessed, planned, evaluated, and implemented patient care plans in coordination with other members of the health care team
- In caring for patients, I prepared and administered medications, provided bedside care, and educated patients on treatments and home care regimens
- I often floated to the medical ICU, neurology, orthopedics, and telemetry
- On an average shift, I provided care for about 10 patients
REGISTERED NURSE - OUTPATIENT CLINIC
PEACHTREE ALLERGY AND ASTHMA
Atlanta, GA
08.1998 - 10.2000
- As an allergy and asthma clinic nurse, I performed patient assessments, pulmonary function tests, allergy tests, and X-rays
- I also created and administered immunotherapy and other medications ordered by the physicians
- Additionally, educated patients on treatments and home care regimens
REGISTERED NURSE - MEDICAL/SURGICAL UNIT
DEKALB MEDICAL CENTER
Decatur, GA
09.1997 - 08.1998
- As a medical-surgical nurse, I was responsible for direct patient care of a general medical patient population
- In this role, I assessed, planned, evaluated, and implemented patient care plans in coordination with other members of the health care team
- In caring for patients, I prepared and administered medications, provided bedside care, and educated patients on treatments and home care regimens
- I often floated to the medical ICU, neurology, orthopedics, and telemetry
- On an average shift, I provided care for about 10 patients
Education
BACHELOR OF SCIENCE IN NURSING (BSN) -
AUBURN UNIVERSITY SCHOOL OF NURSING
Skills
- Classroom experience
- Video instruction
- Finance
- Insurance verification
- Utilization management
- Communication
- Medicaid
- Utilization review
- Medicare
- Inpatient care
- Discharge planning coordination
- Documentation and reporting
- Physician consultations
- Milliman guidelines
- Prior authorization
- Home health care
- Discharge planning
- Outpatient care
- Managed care
- Clinical assessment
- Patient support
- Positive attitude
- Relationship building
- Active listening
References
AVAILABLE UPON REQUEST
Educationandlicensure
BACHELOR OF SCIENCE IN NURSING (BSN), AUBURN UNIVERSITY SCHOOL OF NURSING, REGISTERED PROFESSIONAL NURSE - GEORGIA, 01/31/27
Certification
- REGISTERED PROFESSIONAL NURSE - GEORGIA
- REGISTERED PROFESSIONAL NURSE -eNLC
Timeline
TRAINING SPECIALIST
ANTHEM HEALTHCARE
10.2016 - 11.2024
SENIOR NURSE MEDICAL MANAGER
ANTHEM HEALTHCARE
01.2009 - 10.2016
SENIOR NURSE CASE MANAGER
WELLPOINT (ACQUIRED BY ANTHEM)
10.2006 - 12.2008
MEDICAL UNDERWRITER
WELLPOINT (ACQUIRED BY ANTHEM)
10.2005 - 10.2006
LEGAL NURSE CONSULTANT
KING & SPALDING, LLP
09.2004 - 08.2005
SENIOR NURSE CASE MANAGER, CASE MANAGER, AND UTILIZATION REVIEW NURSE
WELLPOINT (ACQUIRED BY ANTHEM)
09.2001 - 09.2004
REGISTERED NURSE - MEDICAL/SURGICAL UNIT
NEWNAN HOSPITAL
12.2000 - 08.2001
REGISTERED NURSE - OUTPATIENT CLINIC
PEACHTREE ALLERGY AND ASTHMA
08.1998 - 10.2000
REGISTERED NURSE - MEDICAL/SURGICAL UNIT
DEKALB MEDICAL CENTER
09.1997 - 08.1998
BACHELOR OF SCIENCE IN NURSING (BSN) -
AUBURN UNIVERSITY SCHOOL OF NURSING
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