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
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