Linnea Mrozek
Syracuse
Summary
To obtain a challenging position as a Registered Nurse with a company that will allow me to grow professionally using my strong clinical and supervisory skills.
Overview
30
30
years of professional experience
Work History
Quality Assurance Nures
AmTrust Financial
Remote
12.2020 - Current
- Carry out quality assurance oversite activities defined in the Am Trust Medical Case Management and Quality Assurance Standards
- Build out and update quality assurance audit tools for Internal Medical Case Management files as well as Internal utilization review and External Vendor files.
- Complete Monthly audits for Internal Medical Nurse Case Manager, Utilization Review Nurses , as well as External Vendors ( Physical Therapy and Home Health Care)
- Work with managed care leadership and nurses to calibrate quality standards across all regions
- Analysis of Quality Assurance reporting metrics to identify strengths, treads, and provide recommendations which can support and tie into educational training needs for the overall program.
- Track, Monitor, and measure quarterly and annual performance of the program.
- Present reports, findings and recommendations for enhancements and/or changes based on analysis to Managed Care Leadership and Worker's Compensation leadership teams on both internal and external case management programs
Claims Quality Specialist II
Liberty Mutual Insurance
01.2017 - 12.2020
- Complete Monthly Audits timely for Vendor Partners (UR and NCM), and Internal Telephonic Nurse Case Managers
- Participate in Monthly calls with Vendor Partners
- Provide data trends/barriers as well as illustrate opportunities for improvement/strengths to Vendor partners
- Based on trends captured by the QA review process, identify when changes would be appropriate to meet the quality guidelines
- Work with Field & Product managers to recommend or implement needed changes
- Accurately and consistently apply QA Scoring Definitions to files reviewed
- Ensure a quality file review that provides useful technical feedback to all internal and external partners
- Work with the Lead Auditor and QA team on QA questionnaires for all products audited
- Developed and assisted with questions to Improved quality of work provided by Internal and External partners
- Active participant in multiple committees to further employee engagement and customer satisfaction.
Senior Telephonic Medical and Disability Registered Nurse Case Manager
Liberty Mutual Insurance
01.2010 - 01.2017
- Effectively manage assigned caseload of medical/disability cases within company and regulatory guidelines (RN license in NY, NH, NJ, VT, CT, ME, RI, DE, PA and MA)
- Proficient in multiple computer platforms including RCG, Entree and Express
- Effectively managed assigned caseload in National Markets (The Home Depot)
- Communication with claimants, medical professionals, employers, claims staff and others to obtain information necessary to make sound medical decisions
- Respond to various written and telephone inquiries regarding status of cases
- Complete initial case evaluation by assessing injury/disability severity, treatment plan, functional abilities and physical job requirements and establishing case-specific target Return to work dates
- New staff Mentor
- Initiated Regional Mentor Project.
Director of Medical Adult Day Health Program
St. Camillus Health and Rehabilitation Center
01.2009 - 01.2010
- Supervise and coordinate coverage for eleven Adult Day Health Medical Program staff members, including Case Manager, LPN, CNA, RN and Recreation Therapist
- Supervise and coordinates care for Eighty patients enrolled in the Adult Day Health Medical Program
- Develop, revise, and implement Adult Day Health Medical Program policies and procedures regarding NYS DOH Adult Medical Day Care regulations, Nursing, Administrative, Fire/Safety, Quality Improvement/Assurance Program, Abuse Prevention and HIPAA
- Responsible for writing the Annual Report with program statistics
- Accountable for developing and maintaining both a capital and operational budget for the program
- Assist the Skilled Nursing Home Facility's Administration with the VA contract
- Assure compliance to all VA rules and regulations
- Market the Adult Day Health Medical Program to the CNY area.
Occupational Health Coordinator
St. Camillus Health and Rehabilitation Center
01.2008 - 01.2009
- Initiate early intervention and internal investigation of all work-related injuries and illnesses at St Camillus
- Present orientation to all new employees of Policy and Procedure for reporting injuries as well as St Camillus Policy and Procedures on Workplace Violence
- Organized Wellness Fair for Seven hundred employees
- Developed and Educated employees regarding Smoking cessation and Exercise programs
- Assisted with new hire Physical and Performed Yearly Physicals
- Collaboratively with claims staff at C.N.A insurance, the injured worker, physician, supervisor, and other health care professionals to promote timely and early Return - To- Work and achieve the best possible medical outcome for our employee
- Constant communication between supervisors on updates of all Return - To-Work status
- Monitoring the progress of all employees that are in a Light Duty Return - To-Work program
- Maintaining all files including OSHA, NYS Worker's Compensation and medical records for all involved work related injuries.
Admission Liaison Nurse
St. Camillus Health and Rehabilitation Center
01.2004 - 01.2008
- Successfully coordinated pre-admission assessments on acute care patients for the sub acute rehabilitation unit, brain injury unit and continuing care units
- Effective in census management to maintain a 95% in-house capacity
- Designed and implemented programs to increase referral source awareness of St
- Camillus
- Improved hospital relations by utilizing strong, open and honest communication with hospital staff including physicians, administration, nurses and case management
- Assisted sales and marketing departments with increasing the public awareness of the services available at St
- Camillus
- Facilitated admission meetings and managed the admission department in the absence of management.
Registered Nurse/Telephonic Case Manager
The Hartford Insurance Company
01.1998 - 01.2004
- Manage a caseload of 85-95 worker's compensation claims
- Provide disability management by coordinating return to work releases for injured workers
- Provide medical management by coordinating & authorizing medical treatment plans
- Proficiently use Microsoft Applications
- Customer Service focused when interacting with healthcare providers, injured workers, employers, and claims professionals telephonically.
Registered Nurse
St. Joseph's Hospital Health Center
01.1994 - 01.1998
- Representative for the Camillus Dialysis Unit Performance Assessment and Improvement Committee
- Charge nurse for hemodialysis patients
- Care plan team leader for thirty dialysis patients
- Delivered primary care to hemodialysis patients
- Served as Nurse Orienter and Preceptor for recent graduates and nurses new to the center
- Prepared Nursing notes on Patients' charts
- Administered drugs, IV's, and treatments as directed.
Education
Registered Nurse - Associate of Applied Science -
ST. JOSEPH'S HOSPITAL SCHOOL OF NURSING
Syracuse, NY01.1994
Skills
- Quality Improvement
- Audit preparation
- Process Improvements
- Critical Thinking
- Clinical expertise
- Healthcare management
Timeline
Quality Assurance Nures
AmTrust Financial
12.2020 - Current
Claims Quality Specialist II
Liberty Mutual Insurance
01.2017 - 12.2020
Senior Telephonic Medical and Disability Registered Nurse Case Manager
Liberty Mutual Insurance
01.2010 - 01.2017
Director of Medical Adult Day Health Program
St. Camillus Health and Rehabilitation Center
01.2009 - 01.2010
Occupational Health Coordinator
St. Camillus Health and Rehabilitation Center
01.2008 - 01.2009
Admission Liaison Nurse
St. Camillus Health and Rehabilitation Center
01.2004 - 01.2008
Registered Nurse/Telephonic Case Manager
The Hartford Insurance Company
01.1998 - 01.2004
Registered Nurse
St. Joseph's Hospital Health Center
01.1994 - 01.1998
Registered Nurse - Associate of Applied Science -
ST. JOSEPH'S HOSPITAL SCHOOL OF NURSING