Linda Butler
Greenwood,AR
Summary
Expert registered nurse with a diverse background in Managed Care, Case Management, and Utilization Review. Experienced in insurance, acute hospital, skilled nursing facility, home health, hospice, and long term care. Reliable, ethical, healthcare provider with ability to collaborate with multidisciplinary teams. Proficient in documentation and compliance management. Passionate about delivering quality care and facilitating efficient healthcare coordination.
Overview
34
34
years of professional experience
1
1
Certification
Work History
Nurse Care Manager Sr
Elevance Health and Carelon
Richmond, VA
11.2019 - 02.2024
- Responsible for collaborating with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for consumers.
- Performed care management activities within the scope of licensure for members with complex and chronic care needs.
- Ensured medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, out of network services, and appropriateness of treatment setting and level of care.
- Partnered with physician clinical reviewers and/or medical directors to interpret appropriateness of care, intervention planning, and general clinical guidance.
- Collaborated with providers to assess consumer needs for early identification of and proactive planning for discharge. Implements and coordinates a care plan; monitors and evaluates effectiveness of the care management plan and modifies as necessary.
- Served as resource to lower-level nurses, functions as preceptor for new care management staff.
- Assisted with development of care management policies, procedures, and new programs.
- Assisted in problem solving with providers, claims, or service issues
Senior Managed Care Case Manager
Golden Living
Fort Smith, AR
03.1995 - 10.2019
- Telephonic case manager for skilled nursing facilities across multiple states
- Negotiation of cost effective reimbursement
- Contacted insurance carriers to obtain prior authorization and re-authorization for services delivered to patients
- Assisted in coordination of care of patient for discharge to the most appropriate setting
- Used dynamic communication, effective leadership and knowledge to liaise between management, clinical staff and community
- Completed patient data collection, clinical monitoring and liaised with primary health care providers to ensure coordinated care to patients
- Determined medical necessity and cost-effectiveness of services through utilization review processes
- Collection of clinical data and utilization of clinical resources for authorization of services
- Issuance of NOMNC's and IDN's (Integrated Denials) when appropriate
- Maintained strict patient privacy and confidential patient information, taking care to meet all HIPAA guidelines and statues for data security
- Minimized staff turnover through appropriate selection, orientation, training, staff education and development
RN Case Manager
Fort Smith Rehabilitation Center
Fort Smith, AR
12.1989 - 03.1995
- Lowered costs while improving care quality by coordinating services and collaborating with dedicated healthcare team
- Determined and coordinated appropriate level of care to meet individual patient needs
- Advocated for patients by identifying insurance coverage, communicating care preferences to practitioners and verifying interventions met patients' treatment goals
- Collaborated with physicians during medical rounds and team conferences, updated treatment plans, and provided plan of care to patients and families
- Updated and maintained discharge plan of care with physician, members of healthcare team, patients, and families
- Actively participated in family and patient planning processes
- Secured insurance authorizations to acute rehabilitation facilities or long-term care placement
Education
Associate of Applied Science - Registered Nurse
Westark Community College
Fort Smith, AR1983
Skills
- Excellent leadership, interpersonal and communication skills
- Excellent analytical, critical thinking, and problem solving skills
- Expert knowledge in precertification of services
- Expert knowledge of insurance payers, types of coverage, verification of benefits, and contract limitations
- Organization and planning
- Staff training and development
- Relationship and team building
- Strong clinical judgment
- Knowledge in Microsoft Outlook, Word, Excel, Windows, Cisco WebEx, HRS, Solution Central, Care Radius, TEAMS, Application Extender, Max Vault, Medicare CWF, Dorado, PCC, MyCare, SMART, ICD 10, Citrix, My Ability, and Provider Online Portals
Certification
- Registered Nurse - Arkansas
- CCM-Certified Case Manager- #31626 Expires 11/30/25
Additional Information
- Available RN Case Manager
- Staff Nurse Med-Surg -SRMC, Fort Smith, AR
- Nursing Assistant-SRMC, Fort Smith, AR
Timeline
Nurse Care Manager Sr
Elevance Health and Carelon
11.2019 - 02.2024
Senior Managed Care Case Manager
Golden Living
03.1995 - 10.2019
RN Case Manager
Fort Smith Rehabilitation Center
12.1989 - 03.1995
Associate of Applied Science - Registered Nurse
Westark Community College