Lauren Wilson, RN CCM
Deltona,FL
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Telephonic Case Manager
Protegrity Services
Longwood, FL
08.2005
- Medical case management services on runoff lost time files for Dept
- Of Financial Services Division for State of Florida.
President and CEO
Lauren Thomas & Associates, Inc
Deland, FL
06.2002 - Current
- Medical-Legal Nurse Consulting for medical malpractice and personal injury attorneys
- Review of medical records for deviations from medical standards of care
- Furnish attorneys with outcome of medical record review and opinion upon request.
Remote Utilization Review Nurse
OrthoNet, LLC
White Plains, NY
06.2016 - 07.2016
- Reviewing of policy language as it relates to orthopedic surgery referrals for United Healthcare
- Referrals submitted to medical physician for orthopedic referrals not covered in policy.
Remote Telephonic Case Manager
Patriot Care Management
Fort Lauderdale, FL
11.2013 - 02.2016
- Medical case management services for catastrophic and other complex cases
- Coordination with all parties to enable stay at work or return to work opportunities
- Selected by supervisor to mentor new hires and to test drive new software.
Temporary Telephonic Case Manager
Flynn and Associates
Riverside, CA
08.2012 - 10.2013
- Selected as telephonic case manager with Workers Compensation industry leader
- Assigned to numerous jumbo accounts including American Airlines
- Utilization review in line with Utilization Review Accreditation Commission (URAC)
- Requested by Assistant Supervisor for information on my cost containment procedure regarding big savings with durable medical equipment referrals.
Temporary Telephonic Case Manager
Kelly Services, Inc.
Altamonte Springs, FL
04.2010 - 03.2011
- Selected for temporary position with a third-party administrator for Sate of Florida, Department of Financial Services/Workers Compensation Division
- Assignment to large State Account/ University of Florida
- Case management services for lost time and medical only files including utilization review
- Consistently maintained metrics.
Telephonic Case Manager
Amerisys, Inc.
Oviedo, FL
10.2007 - 03.2008
- Case Management services for lost time and medical only files with a focus on return to work and stay at work programs Broward County, Florida Workers’ Compensation Department.
Temporary Telephonic Case Manager
Healthcare Support Staffing, Inc.
Maitland, FL
07.2005 - 08.2005
- Temporary to permanent staffing
- Assigned to and hired by Protegrity Services, Inc.
Agency Staff Nurse
American Medical Services, Inc.
Ormond Beach, FL
02.2002 - 05.2005
- Primary patient care in hospital setting including Intensive Care, Cardiology, Telemetry, Progressive Care Units, and occasional Sub-Acute Care as assigned.
Clinical Staff Nurse
Halifax Medical Center
Daytona Beach, FL
02.1999 - 02.2000
- Primary care nursing Open-Heart Step-Down Unit as well as the occasional Post Cardiac Catheter recovery patient.
Education
Associates Degree in Nursing -
Daytona Community College
12.1995
Skills
- Adept in documentation/record maintenance and organization of unwieldly files
- Accomplished in quickly assessing medical/legal records for appropriateness of medical treatment and return to work status, if applicable
- Demonstrated expertise in effective written and verbal communications, organizational as well as conflict resolution skills
- Proactive in management of case files per telephonic outreach to medical providers for updated medical records, referrals and work status, if applicable, and serve as a clinical resource to claims staff
- Regularly communicate with injured employee and providers Encourage the injured employee to participate in the recovery plan
- Experienced at appointment setting with network providers for IME, second opinions and routine appointments as per jurisdiction
- Skillful ability to manage time, set priorities, meet company metrics, HIPAA requirements and Quality Assurance standards consistently
- Proven ability to manage cost containment/utilization review as per company policies and state laws
- Effective documentation of nurse case management activities, including activity updates and medical and disability case management strategies with attention to detail
- Efficient with intermediate computer software such as Microsoft Outlook, Excel, PowerPoint and Zoom as well as various other documentation/record keeping and communications software
- Experienced preceptor and mentor of new hires with no previous case management experience
- Excellent patient teaching and interview skills
- Strong skills in medical assessment/medical record review
- Proven ability to function well in remote work situations
- Strong in progressing patient RTW via care planning
- Cross-cultural sensitivity
- Problem-Solving
- Relationship Building
- Patient Advocacy
Certification
- Registered Nurse, Florida, 3026002
- Certified Case Manager (CCM), 4210169
Timeline
Remote Utilization Review Nurse
OrthoNet, LLC
06.2016 - 07.2016
Remote Telephonic Case Manager
Patriot Care Management
11.2013 - 02.2016
Temporary Telephonic Case Manager
Flynn and Associates
08.2012 - 10.2013
Temporary Telephonic Case Manager
Kelly Services, Inc.
04.2010 - 03.2011
Telephonic Case Manager
Amerisys, Inc.
10.2007 - 03.2008
Telephonic Case Manager
Protegrity Services
08.2005
Temporary Telephonic Case Manager
Healthcare Support Staffing, Inc.
07.2005 - 08.2005
President and CEO
Lauren Thomas & Associates, Inc
06.2002 - Current
Agency Staff Nurse
American Medical Services, Inc.
02.2002 - 05.2005
Clinical Staff Nurse
Halifax Medical Center
02.1999 - 02.2000
Associates Degree in Nursing -
Daytona Community College