Janette Sepulveda
Rome
Summary
Dedicated Long-Term Disability Case Manager with expertise in disability benefits and medical management. Demonstrated ability to manage complex cases, enhance client satisfaction, and ensure accurate delivery of benefits. Maintains current knowledge of industry regulations to promote efficient case resolution.
Overview
1
1
year of post-secondary education
23
23
years of professional experience
Work History
Long Term Disability Case Manager
Metlife
Rome
05.2008 - 07.2013
- Assessed long-term disability claims for compliance with company policies.
- Collaborated with healthcare providers to gather necessary medical documentation.
- Reviewed and analyzed client files to determine eligibility for benefits, ensuring compliance with company policies.
- Discussed and reviewed details of workers' compensation injuries with relevant parties.
- Communicated decisions clearly to clients regarding their disability status.
- Managed case files efficiently to ensure timely processing of claims.
- Coordinated with internal teams to streamline claim resolution processes.
- Provided support and guidance to clients throughout the claims process.
- Engaged legal counsels to address complex disputes regarding entitlement or benefit amounts.
- Prepared correspondence informing clients about decisions made regarding their claim status.
- Compiled detailed reports on findings from interviews and medical evaluations for supervisor and manager review, supporting informed decision-making.
- Conducted in-depth interviews with claimants to assess their medical history and job responsibilities.
- Evaluated existing policies related to long-term disability cases and recommended changes when necessary.
Licensed Practical Nurse
Eastern Star Nursing Home
Oriskany
05.2004 - 05.2008
- Administered medications and monitored patient responses at Eastern Star Nursing Home.
- Assisted patients with daily living activities and personal hygiene needs.
- Collaborated with nurses and doctors to develop patient care plans.
- Documented patient health records and progress notes accurately.
- Trained new staff on protocols and proper care techniques.
- Communicated effectively with families regarding patient status and care needs.
- Provided emotional support to patients during challenging times at the facility.
- Observed changes in patient's condition and reported any significant changes to the registered nurse or physician.
- Performed physical assessments, including vital signs and health history documentation.
- Monitored vital signs, fluid intake and output levels, glucose levels, and other medical tests results.
- Provided patient care in accordance with physicians' orders and nursing standards of practice.
- Communicated effectively with patients, family members, healthcare team members, and other stakeholders regarding patient care plans or concerns.
- Adhered to facility policies and procedures while providing quality nursing care.
- Managed emergency situations promptly according to established protocols.
- Coordinated with doctors and registered nurses to develop care plans for patients.
- Communicated concerns regarding patients' status, care and environment to nursing supervisors, clinical care supervisors and case managers.
- Looked for physical, emotional, and symptomatic changes in patient condition and obtained necessary care for medical concerns.
Adult Critical Care Nurse
Rome Memorial Hospital
Rome
02.1990 - 05.2004
- Monitored vital signs and administered medications to critically ill patients.
- Assessed and monitored vital signs of critically ill patients.
- Managed the care of patients on mechanical ventilation, optimizing respiratory function and monitoring for complications.
- Managed complex equipment such as ventilators and infusion pumps during procedures.
- Participated in daily rounds with physicians to discuss patient progress and plan of care modifications.
- Collaborated with interdisciplinary teams for patient care plans and interventions.
- Collaborated with interdisciplinary healthcare professionals to create, implement, and adapt individualized care plans.
- Collaborated with doctors to plan post-treatment home care and prevent return hospitalization.
- Educated patients and their families on disease processes, medical procedures, and self-care skills.
- Trained new nurses on protocols for critical care procedures and patient safety.
- Instructed student nurses on proper techniques related to adult critical care nursing.
- Demonstrated leadership skills when supervising staff members assigned to the unit.
- Actively participated in performance improvement initiatives focusing on best practices for adult critical care settings.
- Treated patients with broad range of acute, life-threatening diagnoses.
- Prioritized patient care assignments based on patient conditions to achieve optimal outcomes.
- Assisted in emergency response situations, providing immediate care to patients.
- Performed emergency medical procedures, such as advanced cardiac life support (ACLS), when necessary.
- Documented patient progress and care activities in electronic health records systems.
- Provided emotional support for family members during end-of-life situations.
- Conducted comprehensive physical assessments on admission and discharge of critically ill patients.
Education
Camden High School
Camden , NYLPN - Licensed Practical Nurse
Verona Oneida Madison Boces
Verona , NY 09.1984 - 06.1985
Some College (No Degree) - Nursing
Mohawk Valley Community College
Utica, NYSkills
- case management
- claim assessment
- medical documentation
- healthcare compliance
- policy evaluation
- Disability law knowledge
- Insurance expertise
- social security advising
- patient care coordination
- Documentation proficiency
- Disability knowledge
- client needs assessments
- Decision-making
- time management abilities
- interviewing skills
- CPR ACLS trained
- effective communication
- team collaboration
- teamwork
- emotional support
- organizational skills
- self-motivation
- public policy
- excellent communication
Timeline
Long Term Disability Case Manager
Metlife
05.2008 - 07.2013
Licensed Practical Nurse
Eastern Star Nursing Home
05.2004 - 05.2008
Adult Critical Care Nurse
Rome Memorial Hospital
02.1990 - 05.2004
LPN - Licensed Practical Nurse
Verona Oneida Madison Boces
09.1984 - 06.1985
Camden High School
Some College (No Degree) - Nursing
Mohawk Valley Community College