Lucinda Rogers
Sicklerville,NJ
Summary
Accomplished RN with over 14 years of experience and 6+ years specializing in case management within the biotech sector, focusing on rare diseases. Demonstrated expertise in navigating the insurance landscape, effectively managing patient transitions from clinical trials to commercial drug launches. Proven track record in immunology, hematology, nephrology, and neurology, known for enhancing customer satisfaction and driving operational improvements. Aiming to leverage innovative strategies and team growth to deliver exceptional patient services and cost-effective access solutions.
Overview
10
10
years of professional experience
1
1
Certification
Work History
National Patient Services Float, Neurology
Alexion Pharmaceuticals, Inc.
01.2018 - Current
- Leverage expertise to strategize engagements in payer dicussions with stakeholders.
- Specialized in payer policy, buy-and-bill methods, and prescription processes.
- Expertise in Medicare, commercial, and managed care knowledge.
- Served as an informal leader and coach to team members.
- Maintained expert understanding of formulary requirements, exclusion criteria, denial appeals, and prior authorization for diverse care sites.
- Mentored and trained new team members on policies and procedures, and effective workload strategies.
- Collaborated with Field Reimbursement Managers to educate healthcare offices on denial appeals, access barriers, and formulary policies.
- Spearheaded creation of patient services funding manual set for year-end release.
- Played a key role in drafting and implementing a REMS-compliant vaccination manual.
- Participated in workstreams focused on enhancing user experience.
- Explained benefit verification outcomes to patients and healthcare providers.
- Instructed healthcare staff on leveraging web-based programs for patient assistance.
- Worked with senior management, sales, compliance, legal teams to offer valuable suggestions to meet objectives.
- Delivered top-tier case management support to complex HCP accounts.
- Expertise in finding coverage for uninsured and underinsured patients.
- Served as subject matter expert for Free Drug program, copay, funding, and department operations.
- Maintained stringent compliance with all guidelines, ensuring thorough documentation of activities.
- Assisted colleagues in achieving the highest quality for managed cases.
Field Service Coordinator-RN
WELLCARE HEALTH PLANS
08.2016 - 07.2018
- Oversaw treatment plans for vulnerable individuals experiencing multiple health issues.
- Completed comprehensive needs assessments for members through in-person and telephonic interactions focusing on medical, behavioral, functional, cultural needs as well as SDoH factors.
- Formulated and implemented personalized care plans addressing members' specific needs to achieve the best health results.
- Worked with internal care units, medical providers, and local resources to develop and apply the care plan.
- Provided referral and linkage as appropriate and accepted by the member (may include internal consult opportunities such as Housing Navigator, Pharmacy Team, Peer Specialist, etc.). or community-based provider referrals, such as PCPs, specialists, medication-assisted therapy referrals, etc.
RN Field Case Manager
UNITED HEALTHCARE
02.2015 - 08.2016
- Collaborated with Case Managers and Medical Directors to devise solutions for patient access.
- Secured vendors and obtained competitive pricing for home modifications aligned with patient requirements.
- Devised plans and sanctioned suitable home care services.
- Managed the implementation of cost-effective, high-quality care in line with clinical standards.
- Discovered suitable alternative and unconventional resources.
- Facilitated seamless coordination of resources across multiple locations for optimal service delivery.
- Engaged members, families, physicians, and healthcare providers in long-term care planning.
- Planned, organized, and executed strategic interventions in line with patient requirements using the care management framework.
- Maximized resource use, leading to better self-care outcomes.
- Evaluated extensive multi-disciplinary medical records to determine health care needs of Medicaid recipients.
Regional Staff Nurse (Temp. Position)
DEPARTMENT of HUMAN SERVICES/ OFFICES of COMMUNITY OPTIONS
08.2014 - 01.2015
- Completed in-depth clinical assessment form for periodic medical review functions.
- Conducted comprehensive clinical assessments in nursing homes, assisted living facilities, boarding homes and clients' residences for MLTSS and State plan eligibility.
- Reviewed detailed, multidisciplinary health records to assess the specific needs of Medicaid patients.
- Offered essential nursing consultation to the team regarding client's clinical status.
- Conducted thorough assessments to recommend suitable placements for patients.
- Counseled clients and their families regarding community health resources and alternatives to long-term care facilities.
- Developed relationships with community services, nursing professionals, health agencies, and medical assistance providers regarding the placement of, or alternative care for, eligible recipients.
- Performed reviews for MLTSS eligibility, and maintained ongoing liaison with the regional office staff and managed care organizations.
- Developed and maintained interdepartmental relationships for effective healthcare initiatives.
- Coordinated response to provider, staff, and departmental requests through effective email management and issue resolution.
- Examined medical records to assess Nursing Facility Level of Care for MLTSS eligibility.
Education
Bachelor of Science - Nursing
Chamberlin College of Nursing
01.2014
Associate Degree - Nursing
Raritan Valley Community College
01.2010
Skills
- Hub management
- HIPAA compliance
- Quality assurance
- Patient satisfaction
- Project management
- Process implementation
- Ethical Problem Solving
- Analytical skills and strategic implementation
- Knowledge of Healthcare Delivery Systems
- Communication skills
- People management
- Interpersonal skills
- Organizational skills
- Multitasking
- Adherence to regulations
- Call quality
- Implementation of company processes
- SOP
- Regulatory policies
- Patient service experience
- Integrity
- Trust building
- Credibility
- CRM, EHR, Salesforce, and omnichannel proficiency
Certification
- Licensed (NJ) Registered Nurse
- Certified Case Manager
- Certified NJ choice-HC
Affiliations
- President's Honors for Academic Excellence
- Enjoys traveling across the United States with family
Timeline
National Patient Services Float, Neurology
Alexion Pharmaceuticals, Inc.
01.2018 - Current
Field Service Coordinator-RN
WELLCARE HEALTH PLANS
08.2016 - 07.2018
RN Field Case Manager
UNITED HEALTHCARE
02.2015 - 08.2016
Regional Staff Nurse (Temp. Position)
DEPARTMENT of HUMAN SERVICES/ OFFICES of COMMUNITY OPTIONS
08.2014 - 01.2015
Bachelor of Science - Nursing
Chamberlin College of Nursing
Associate Degree - Nursing
Raritan Valley Community College
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