LISA PRIDEMORE, RN, CCM
Camby,IN
Summary
Dedicated Case Manager with a strong foundation in promoting health, wellness, and safety across organizations. Focused on preventing work-related accidents and facilitating full-duty return to work for employees. Skilled in implementing streamlined processes and fostering professional growth among team members.
Overview
1
1
Language
20
20
years of professional experience
Work History
Medical Case Manager II
IMG
07.2019 - Current
- Medical case management for International workers' compensation, Defense Based Act claims (DBA military contractors), Maritime, Jones Act, Longshoremen's, Foreign Voluntary Comp, and Domestic Workers Compensation claims.
- Collaborate with Medical Director and SVP of clinical services to review claims and ensure progression of recovery for all claimants.
- Perform utilization reviews to assess the appropriateness of medical services provided.
- Procedure and lifetime medical cost summary reports, and Medicare set aside reports.
- Cost Research for current and lifetime care to allow jurisdictions to accurately assess settlements of claims.
- Obtain necessary DME/supplies while adhering to cost containment practices and government regulations.
- Onboard and train medical staff for IWC/DBA department since November 2019.
- Collaborate with sales/marketing to articulate medical case management services, enhancing client acquisition and retention; attended conferences including RIMS, DBA/Longshoremen's, and Workers Comp Institute.
- Cross trained with travel insurance team to provide medical review to ensure care provided is appropriate for the country they are currently in and to facilitate medical evacuation or repatriation if needed to receive appropriate care.
Medical Case Manager II
Travelers Insurance
11.2011 - 07.2019
- Oversaw medical management and disability processes
- Performed reviews on causality and utilization
- Coordination of medical care ensuring adherence to jurisdictional requirements
- Executed cost containment strategies through effective utilization of in-network providers.
- Collaborated with employers in HR and EHS to facilitate job analysis and modified duty for permanent disabilities and to progress to full duty upon full recovery.
- Provided backup support for Major Case Unit handling CAT claims
- Conducted medical reviews for in-house legal team to support case decisions and ensure compliance.
- Conducted medical reviews for Investigate Unit's compensability assessments
Medical Department Manager
Boston Scientific
09.2009 - 01.2011
- Directed the daily functions of the medical department to deliver onsite care for over 1000 employees experiencing work-related injuries and illnesses.
- Case Management of all work related injuries including participation in file reviews with TPA providing guidance and direction on reserves & claim handling stateside and global claims
- Maintained OSHA log and conducted required testing/training including onsite physicals and Hearing Conservation Program maintenance.
- Designed wellness challenges to engage employees in healthy lifestyle choices.
- Managed all ADA, FMLA, & STD/LTD programs and all logs and reported associated.
- Contributed as a member of the Environmental Health, Safety, and Sustainability department to ensure compliance and promote safety.
- Created & Managed first responder program providing education quarterly (Health safety, CPR, First Aid, and other required training)
- Work in coordination with the Environmental Health and Safety Manager to ensure all OSHA standards, trainings, and testing are completed timely.
- Conducted ergonomic assessments and modified workspaces
Occupational Health Nurse
Delta Faucet
09.2006 - 11.2008
- Onsite medical care for ill or injured employees
- Maintained OSHA log and conducted required testing/training including onsite physicals and Hearing Conservation Program maintenance.
- Designed wellness challenges to engage employees in healthy lifestyle choices.
- Managed all ADA, FMLA, & STD/LTD programs. Updated & revamped these programs at all locations to provide ease of tracking.
- Managed first responder program providing education quarterly (Health safety, CPR, First Aid, and other required training)
- Traveled quarterly to multiple plant sites to ensure OSHA documentation compliance and delivered updated training/testing to staff and workers.
- Managed occupational health assessments, injury evaluations, and return-to-work clearances for associates.
- Partnered with EHS teams to identify trends, reduce injury risk, and strengthen prevention programs.
- Educated associates on wellness, ergonomics, and injury prevention practices to support healthier work habits.
- Conducted regular health screenings to detect potential health issues early, improving overall workforce well-being.
- Assisted with accident investigation program to identify root cause of incidents and near-misses.
Education
Associates Degree - Nursing
Excelsior Regents New York
Associates Degree - Practical Nursing
IVY Tech Columbus, IN
Skills
- Healthcare management
- Previous certifications: COHC, CWCP, ACLS, ATLS, PALS
- BLS/ACLS/PALS/Heartsaver AED instructor
- ISO 9001 training
- HazCom Training
- Healthcare Leadership Healthcare Process Improvement
- Proficient computer skills including Microsoft Office professional suite that includes proficiency with Excel, Access, and PowerPoint
- EMR program development
- Current RN Indiana licensure w/compact license
- Certified Case Manager through ACCM
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets for catastrophic injuries requiring lifetime assistance.
- Reduction of work place injuries as well as improved general health of workers by providing wellness challenges and working with team to reconfigure work flow for production workers.
- Kaizen events to help identify areas of need to reduce work injuries. Obtain Six Sigma Green Belt doing this. Working on Black belt thru certification for continuous improvement.
Languages
English
Native or Bilingual
Timeline
Medical Case Manager II
IMG
07.2019 - Current
Medical Case Manager II
Travelers Insurance
11.2011 - 07.2019
Medical Department Manager
Boston Scientific
09.2009 - 01.2011
Occupational Health Nurse
Delta Faucet
09.2006 - 11.2008
Associates Degree - Practical Nursing
IVY Tech Columbus, IN
Associates Degree - Nursing
Excelsior Regents New York