Joanne Masters
Rocklin,CA
Summary
Experienced organized and dependable Licensed Vocational Nurse Case Manager successful at managing multiple priorities with a positive attitude. Ability to work at home remotely with private office with High-Speed Internet in place. Ready for new opportunity to apply exceptional nursing and case management skills.
Overview
23
23
years of professional experience
Work History
Prior Authorization Nurse II
Centene/Health Net
Sacramento, CA
12.2019 - 01.2022
- Performed telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approved services or forwarded requests to Medical Director with recommendations for other determinations. Processed and mailed denial and/or modification letters to members based on Medical Director decision. Collaborated with various staff within provider networks and case management team electronically or telephonically to coordinate member care. Provided clinical knowledge and acted as clinical resource to non-clinical team staff. Entered and maintained pertinent clinical information in various medical management systems. Obtained additional information as needed. Reviewed and processed urgent and non-urgent requests. Worked independently and as team.
Home Health Private Duty Nurse
Maxim Health Care
Sacramento, CA
08.2018 - 11.2019
- Provided one-on-one care to home bound client with chronic illness. Assessed, evaluated and provided services as indicated by Plan of Care. Attended doctor's appointments and other outings with patient.
- Stocked and maintained adequate supplies in patient's home. Documented all patient care information. Helped keep client healthy and improve quality of life. Provided patient and family education.
Complex Nurse Case Manager
Coast HealthCare/Tennent
Cypress, CA
02.2015 - 06.2018
- Partnered with physicians, social workers, activity therapists, nutritionists and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems. Managed caseload of 75+members.
- Reduced care costs without sacrificing quality through service coordination and multidisciplinary collaboration.
- Consulted with clinicians to devise and manage ongoing care plans for at-risk patients.
- Addressed delays in discharge, postponed procedures and discharge equipment unavailability.
- Initiated case management screening assessment, reviewing claims history, encounter history, and chronic conditions.
- Provided timely updates on clients as required.
Telephonic Nurse Case Manager
Easy Choice Health Plan
Cypress, CA
06.2014 - 01.2015
- Collaborated with other health care professionals regarding plan of care and variances in plan implementation to achieve outcomes.
- Interfaced with third-party payers, insurance companies and providers for utilization review activities and submitted timely reports to clients and providers.
- Screened medical records and information for necessity and appropriateness and referred for physician review cases not meeting medical criteria.
- Collected and inputted case data in managed care system and timely and accurately generated required correspondence and review notification for management.
- Evaluated patients referred for case management to determine physical, mental, financial and psychosocial status by utilizing comprehensive, standardized criteria to identify existing and potential needs.
- Updated treatment plans on monthly basis with latest intervention strategies and progress notes.
Telephonic Nurse Case Manager
Affiliated Doctors Of Orange County
Orange, CA
07.2012 - 06.2014
- Reviewed for emergent/urgent and continued stay requests for appropriate care and setting. Completed medical necessity and level of care reviews for requested services using clinical judgement. Participated in utilization management committee meetings. Developed evidenced based plan of care that was member centric and based on risk and acuity. Collaborated and communicated with ancillary providers, PCP, specialists, or other involved members of healthcare delivery team.
Telephonic/Ambulatory Case Manger for Worker's Com
Tri-Star Risk Management
Santa Ana, CA
01.2004 - 01.2006
- Assessed medical needs by evaluation and assessment of subjective, objective symptoms, and complaints, evaluation of injured worker's functional abilities in order to formulate and develop plan of care with specific goals and objectives. Applied established protocol, criteria, guidelines, references and resources to determine medical appropriateness of services provided to injured workers in cost-effective manner. Communicated with medical providers and employer to return injured employee to work, either modified or full duty. Ongoing monitoring and gathering of information from patients and providers of care. Provided utilization review. Collaborated with Medical Director and sent requests as appropriate per guidelines.
Chiropractor
Masters & Potts Chiropractic
Downey, CA
01.1994 - 01.2006
- Conducted patient history reviews and physical, neurological and orthopedic examinations to assess conditions and present disorders.
- Advocated for specialized support devices to patients and pain management regimens to achieve recovery goals.
- Diagnosed neuromusculoskeletal conditions and performed corrective adjustments.
- Owner and Operator; started business from scratch.
- Counseled patients about lifestyle choices impacting injuries, conditions and recovery.
- Implemented pain management strategies and specialized operations to improve patient health and reach recovery objectives.
Education
Doctor of Chiropractic - Chiropractic
Cleveland Chiropractic College
City Of Los Angeles, CA04.1984
Licensed Vocational Nurse - Nursing
Los Angeles Trade Technical College
Los Angeles, CA01.1976
Skills
- High level of autonomy
- Quick study
- Loyal and dependable
- Motivated
- Detailed
- Problem resolution capability
- Effective communicator
- Experience with ODG, InterQual, and Milliman
- Coordination
- Critical thinking
- Time Management
Timeline
Prior Authorization Nurse II
Centene/Health Net
12.2019 - 01.2022
Home Health Private Duty Nurse
Maxim Health Care
08.2018 - 11.2019
Complex Nurse Case Manager
Coast HealthCare/Tennent
02.2015 - 06.2018
Telephonic Nurse Case Manager
Easy Choice Health Plan
06.2014 - 01.2015
Telephonic Nurse Case Manager
Affiliated Doctors Of Orange County
07.2012 - 06.2014
Telephonic/Ambulatory Case Manger for Worker's Com
Tri-Star Risk Management
01.2004 - 01.2006
Chiropractor
Masters & Potts Chiropractic
01.1994 - 01.2006
Doctor of Chiropractic - Chiropractic
Cleveland Chiropractic College
Licensed Vocational Nurse - Nursing
Los Angeles Trade Technical College
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