
Accomplished Registered Nurse Case Manager with 9+ years of experience dedicated to quality care of diverse patients. Skillfully blend hands-on skills with advanced background in NICU settings. Work effectively with all levels of healthcare providers, physicians and administrators to address patient needs.
Worked as telephonic Certified RN Case Manager providing case management services to military persons and their families. UM experience with Interqual and Milliman, build/review/approve/deny referrals, reviews with Medical Directors and Second Level Review RNs/MDs. Beneficiaries range from newborn to 65yo, with focus on babies discharged from NICU. Assist beneficiaries with filing claims and/or expediting processing by assisting with obtaining proper documentation. Experienced with working along with Military Treatment Centers and assisting with finding civilian providers in the Tricare Network. Work with Health Net Federal Services for beneficiaries moving from East to West and West to East Regions. Assist UM by working overtime processing referrals when UM is behind. Other duties as assigned.
DC planning for patients whether they are going home or to a facility, working with MDs, admission liaisons at facilities, placing referrals, ordering DME, obtaining scripts, patient and family education and follow up.
Staff RN Level II NICU attended high risk deliveries, cared for fragile neonates, worked with multidisciplinary team to provide best care for babies and their family.
Staff RN Level III NICU attended high risk deliveries, cared for fragile neonates, worked with multidisciplinary team to provide best care for babies and their family.
Comments from my end of the year performance review for 2021:
Julie is a solid performer and conveyor of care. Her skill, knowledge, and clinical expertise prove her a vital member of the health care team. She is kind, compassionate, and much appreciated by her beneficiaries.
Julie has successfully met 2021 CM performance goals and key performance indicators of established goals, delivered positive results, and acted as a patient advocate for the beneficiaries she serves. Documents in the nurse platform process promoting consistent, systematic, and an accurate depiction of interventions and outcomes to meet audit criteria and to ensure contractual requirement are met. Quality audit scores exceed threshold with an overall audit average of 100%. Julie has maintained an average caseload of 69 enrolled cases throughout the year. Coordination of benefits (COB) cases are at 17% of overall caseload, this is especially noteworthy having a large percentage of her cases open and engaged. A positive customer experience involves interactions that consistently exceed the needs and expectations of the beneficiary.
Julie's high volume of pediatrics patients and satisfied parents attest her commitment to Humana values of Perfect Service.
Exhibits Humana values day to day, "Thrives Together." Julie was/is supportive of assisting the UM department in meeting/maintaining government contract standards during time of critical staffing. Worked after hours and weekends performing clinical reviews for referrals and authorizations. Improves health outcomes. Exceptional communication skills and ability to educate other on complex issues.