Interests
Summary
Accomplishments
Skills
Work History
Education
References
Overview
Generic

Laquinta Salary

Danville,IN

Interests

Writing

Learning new languages

Personal development activities

Summary

With over 24 years of experience in leadership, training, and support roles, including 10+ years in case management, Consistently deliver exceptional results. Developed an approach to training and independent productivity has led to significant profit increases in the millions through education, billing, and cost analysis. Additionally, Excel in assessing cost analysis to increase profit and decrease expenditures, with expertise in acute trauma in hospital settings and nursing management. Proficient in various systems and tools, such as ICD/CPT coding, REV codes, DRG, Milliman, Cerner, Smartweb, NextMD, Microsoft Excel, motivational interviewing, medical report analysis, private insurance/Medicare/Medicaid reimbursements, private practice, multi-practice population management for private practice, and corporate vendor consultation and management for a Fortune 500 company.

Accomplishments

  • Collaborates and lead staff in the involvement of our company's two community outreach program for the young and the elderly.
  • Created and chaired the largest ERG in our company's history.

Skills

  • Case Documentation
  • Clinical assessment
  • Care Coordination
  • Quality Improvement
  • Interdisciplinary Collaboration
  • Healthcare regulations
  • Discharge Planning
  • Problem-Solving
  • Multitasking
  • Excellent Communication
  • Decision-Making
  • Relationship Building

Work History

Medical Case Manager

Progressive Fleet & Specialty Insurance Company
01.2019 - Current
  • Manage claims of approx 60+ per month, along with: surgery reviews, pharmacy reviews, field case manager management/reviews, utilization reviews, vendor management, and overall medical consult (SME) for multiple departments
  • Evaluated treatment plans against individual goals and healthcare standards.
  • Coordinated care of injured workers by liaising with hospital staff to organize treatments and program resources.
  • Identified at-risk patients and provided targeted interventions to reduce potential complications and hospitalizations.
  • Evaluated clinical data and adjusted treatment plans as needed, leading to improved patient health outcomes.
  • Managed complex cases involving multiple chronic conditions, resulting in improved quality of life for patients.
  • Assist with vendor contract negotiations and nursing policy development
  • Spot audits on FCM bills to review contract compliance
  • Assist with meeting budgetary goals.

RN Supervisor in Integrated Management/Team Lead, RN Case Manager

IU Health Methodist
01.2016 - 01.2019
  • Educated MD and staff on length of stay per guidelines for appropriate discharge
  • Managed a team of over 32 case managers, role includes: teaching, creating standard work, managing schedules, conflict resolution, personnel attentive listening, new hire training, and reinforcing disciplinary actions instituted by manager.
  • Managed critical situations calmly and efficiently, providing guidance to the nursing team during emergencies.
  • Improved patient satisfaction scores by fostering a collaborative and supportive team environment.
  • Cultivated an atmosphere of teamwork and open communication among staff members, resulting in a more cohesive work environment and greater job satisfaction for the nursing team.
  • Increased staff retention rates through effective mentoring, coaching, and professional development opportunities.
  • Served as an approachable leader who consistently addressed concerns raised by both nursing staff and families regarding patient care issues or operational challenges within the unit effectively resolving them promptly whenever possible.

ACO Population Health Manager/Interim Supervisor

American Health Network
01.2013 - 01.2016
  • Managing complex patients for 22 advanced practitioners and supplemental staff requiring travel to 3 offices weekly
  • Generate reports and assessing Milliman guidelines for target demographic to analyze appropriate actions
  • Educating patients on managing healthcare with PCP via motivational interviewing
  • New employee training, pilot project manager for Hendricks County, Bi-state Moral Officer
  • Accomplished multiple tasks within established timeframes.
  • Monitored and analyzed business performance to identify areas of improvement and make necessary adjustments.
  • Achieved departmental goals by developing and executing strategic plans and performance metrics.
  • Mentored junior team members for career advancement, fostering a pipeline of future leaders within the organization.

Medical Case Management

Travelers Insurance
01.2010 - 01.2013
  • Managed the health status and applicability of treatment in correlation to injuries with workman's comp claims
  • Applied effective problem-solving techniques when faced with challenging clinical scenarios or unexpected changes in case management plans.
  • Approval of consultations and continued dynamic care with multiple providers using ICD-9/CPT codes and Milliman guidelines
  • Update insured/patient/provider with information relevant for progression of claim
  • Facilitate open forum for communication with all parties involved including attorneys
  • New employee training
  • Maintained accurate records and documentation, ensuring compliance with regulatory requirements and facilitating seamless audits.
  • Participated in ongoing professional development activities to maintain knowledge of current best practices related to medical case management.
  • Managed complex cases involving multiple medical conditions, coordinating care with interdisciplinary teams to ensure timely treatment delivery.
  • Directed cost management, utilization management, quality assurance and medical protocol development initiatives.
  • Implemented evidence-based practices into daily case management activities, promoting positive client outcomes.

RN/Charge Nurse

IU Health Hospitals
01.2005 - 01.2011
  • Provided training for student nurses, new grads, and new hires
  • Worked in multiple units: case management, neuro, ortho, med/surg, IMCU, NCC and PCU
  • Managing unit of 9-10 RN's and 3-5 support staff to run the unit without sentinel events
  • Coordinate unit flow with Bed Control and House Supervisor
  • Administered medications accurately and safely, reducing medication errors and adverse reactions.
  • Enhanced patient satisfaction through effective communication, empathy, and timely response to their needs.
  • Collaborated with interdisciplinary teams for comprehensive patient care plans, resulting in better health outcomes.
  • Improved patient outcomes by providing high-quality nursing care and implementing evidence-based practices.
  • Educated patients on disease management and self-care techniques, promoting lifestyle changes for improved health.
  • Managed care from admission to discharge.

Utilization Review RN

Wellpoint
01.2008 - 01.2009
  • Use of ICD and CPT coding per Milliman Guidelines for all approvals/denials
  • Prior authorization, concurrent, and post stay reviews per guidelines
  • Authorization for DME, out of network physician office visits, specialist authorization, and surgical procedures
  • Coordinate with the Medical Director, Case management teams, and facilities to follow policy and guidelines set forth by company standards.
  • Mentored new nursing staff, contributing to a supportive work environment and improved retention rates.
  • Managed patient caseload of 70+ effectively, ensuring timely interventions and thorough follow-ups to mitigate potential complications.
  • Coordinated discharge planning efforts with social workers, case managers, and other multidisciplinary team members for smooth transitions after discharge.

Education

Bachelor of Science - Nursing

Indiana University - Purdue University Indianapolis
Indianapolis, IN
05.2010

Associate of Science - Nursing

Purdue University Calumet
Hammond, IN
05.2005

License Practical Nurse- LPN - Nursing

Ivy Tech College
Gary, IN
05.2001

References

Upon request

Overview

20
20
years of professional experience

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Laquinta Salary