Justin Alexander
Durham,NC
Summary
Dedicated healthcare professional with extensive experience in medical case management and insurance-based care coordination. Proven ability to evaluate clinical documentation, identify risk factors, and implement strategies that support cost-effective care planning. Committed to enhancing patient outcomes through effective communication and collaboration with multidisciplinary teams. Passionate about leveraging expertise to drive improvements in healthcare delivery and ensure optimal patient care.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Medical Case Manager
Blue Cross and Blue Shield of North Carolina
07.2023 - Current
- Managed post-discharge care coordination for members transitioning from hospital to home to reduce admissions and improve outcomes
- Assessed medical, social, and financial risk factors impacting recovery and ongoing care needs
- Reviewed clinical documentation, treatment plans, and utilization patterns to ensure appropriate and cost-effective care
- Collaborated with providers, social workers, and community resources to develop individualized care plans
- Educated members on benefits, coverage, and available services to support treatment adherence
- Monitored high-risk cases and adjusted care plans based on evolving clinical needs and outcomes
- Documented case activity and maintained compliance with regulatory and insurance guidelines
RN Case Manager
WakeMed Cary Hospital
09.2021 - 06.2023
- Coordinated patient care from admission to discharge, ensuring safe transitions and continuity of care
- Assessed clinical, social, and financial factors to identify potential barriers to recovery
- Developed individualized care plans and collaborated with interdisciplinary teams, including physicians, nurses, and social workers
- Reviewed medical records, monitored outcomes, and documented care interventions in compliance with hospital and regulatory standards
- Supported utilization review and resource allocation to optimize patient care and reduce readmissions
- Facilitated onboarding of new hires and conducted competency audits for departmental standards.
Clinical Research Coordinator
Raleigh Neurology Associates, P.A.
05.2021 - 08.2021
- Coordinated clinical trial activities including patient screening, enrollment, and follow-up
- Reviewed medical records and study criteria to determine participant eligibility
- Ensured compliance with study protocols, regulatory requirements, and documentation standards
- Collected and maintained accurate clinical data for research and reporting
- Collaborated with investigators and healthcare teams to support study execution
Vaccine Administration Nurse
Mako Medical
02.2021 - 07.2021
- Supported Wake County's public health initiatives by assisting with large-scale COVID-19 vaccination efforts.
RN Case Manager
Duke University Hospital: Employee Health and Occupational Wellness
08.2020 - 04.2021
- Managed return-to-work and care coordination for healthcare employees during the COVID-19 pandemic
- Assessed medical readiness, exposure risk, and workplace safety requirements
- Interpreted public health guidance and organizational policies to determine work clearance and restrictions
Clinical Nurse II
Duke Regional Hospital: 7-3 Duke Rehab Institute
09.2018 - 07.2020
- Provided direct patient care in an acute rehabilitation setting, assessing medical status and functional progress
- Developed and implemented individualized care plans in collaboration with interdisciplinary teams
- Monitored patient outcomes and adjusted interventions to support recovery goals
- Educated patients and families on rehabilitation plans and safe care practices
- Maintained accurate clinical documentation and ensured compliance with healthcare standards
Education
Bachelor of Science - Nursing
University of Mount Olive
08-2020
Diploma - Nursing
Watts School of Nursing
05-2018
Associate of Science - Health Sciences
University of Mount Olive
05-2018
Skills
- Clinical knowledge and risk assessment
- Clinical documentation review
- Healthcare utilization management
- Data analysis and decision support
- Regulatory and policy compliance
- Interdisciplinary collaboration
- Cost containment and resource planning
- Member education and communication
- Subject matter expert - clinical records request, via FHIR applications
Certification
- Certified Case Manager - Commission for Case Manager Certification (CCMC) #4273638 Exp: 05/20/2031
- NC Registered Nurse Permanent Multi-State Compact License #308543 Exp: 05/31/2028
Timeline
Medical Case Manager
Blue Cross and Blue Shield of North Carolina
07.2023 - Current
RN Case Manager
WakeMed Cary Hospital
09.2021 - 06.2023
Clinical Research Coordinator
Raleigh Neurology Associates, P.A.
05.2021 - 08.2021
Vaccine Administration Nurse
Mako Medical
02.2021 - 07.2021
RN Case Manager
Duke University Hospital: Employee Health and Occupational Wellness
08.2020 - 04.2021
Clinical Nurse II
Duke Regional Hospital: 7-3 Duke Rehab Institute
09.2018 - 07.2020
Diploma - Nursing
Watts School of Nursing
Associate of Science - Health Sciences
University of Mount Olive
Bachelor of Science - Nursing
University of Mount Olive