Lynnette Atmore
Batavia
Summary
Experienced management professional with a proven track record of leading teams and implementing strategic initiatives in the Enterprise Transplant department. Skilled in fostering collaboration and cultivating strong relationships with stakeholders. Committed to delivering exceptional results and contributing to organizational success. Proficient in team leadership, strategic planning, and operational management. Utilizing effective communication and organizational skills to drive project success. Demonstrated ability to foster productive work environments and consistently achieve set goals.
Overview
22
22
years of professional experience
1
1
Certification
Work History
Manager II Transplant and Specialty Services
Anthem Blue Cross
01.2022 - Current
- Establish new policies and procedures including roll out, training and change management
- Personnel management including interviewing / hiring / performance reviews
- Conduct monthly staff meetings to update staff with any department changes
- Manage client escalations
- User acceptance testing of CM and UM software systems
- Ensure departmental quality through Monthly Audits and necessary retraining to increase scores to reach benchmark
- Development of the Specialty Therapy program in collaboration with Medical Directors/ Contracting/ Account Managers
Transplant Nurse Lead
Anthem Blue Cross
01.2014 - 01.2022
- Ensure cases comply with TAT
- Answering questions from Nurses/ benefit specialist
- Transplant Claims resource
- HMO/PMG/State Health Benefit Plan Subject Matter expert
- Assisting with meetings/ projects, as assigned by management
- Maintaining multi-state licensure
- Assisting with Pre-determinations/ Inpatient cases as needed
- Interacting with Medical Directors as needed
- Keeps the Jointly Administered Accounts and WCIC cases completed
- System Testing as needed
- Created new process for MOU contract for the CA Health System
- Responsible for review of Gene Therapy reviews including: Zolgensma and Luxturna.
- Covered for management as needed
Senior Specialized Case Manager
Anthem Blue Cross
01.2008 - 01.2014
- Pre-determination for requested transplants such as heart, lung, liver, pancreas and both allogeneic and autologous bone marrow transplants.
- Utilization Management of all inpatient transplant related admissions
- Case management of the member from notification of transplant approval to goals being achieved post-transplant.
- Teaching post-stem cell and solid organ transplant care
- Mentoring new nurses and acting as Team Lead when needed
- Co-Chair of the “Donate Life Day”
- Assisted in development of the State Benefit Health Plan program for GA
Care Coordinator
Mercy Clermont Hospital
01.2007 - 01.2008
- Responsible for utilization review consisting of a daily case load of 35-40 using Millman and InterQual Guidelines for both Med-Surg unit and the ICU
- Denial management with a 100% over-turn rate
- Occasionally filled in for Discharge Planners on the various units setting up Home Care, Skilled Nurse Facility and LTAC transfers
Case Manager
Brown County General Hospital
01.2005 - 01.2008
- Development of the case management/ utilization review program
- Co-Chair Brown County Health Fair
- 100% Chart Review
Case Manager
Blue Cross Blue Shield of Tennessee
01.2003 - 01.2005
- Catastrophic case management for the commercial and Medicaid population.
- Development of an Intense Case Management Program for a specific employer group which included weekly contact that is still continues today.
- Kidney transplant case management.
- Development of member specific care plans to achieve personal patient goals.
- Management and cost containment for above average number of catastrophic cases.
Education
Bachelor of Science -
University of Michigan
05.1990
Skills
- Proficient in Milliman Care Guidelines
- Experienced with CMS and NCQA protocols
- Claims cost assessment
- Claims processing review
- Quality control and review processes
- Experienced in evaluating and addressing patient requirements
- Qualified case manager (CCM)
- Facilitation of patient-centered care
- Licensed to practice in 49 states and DC
- Service-oriented communication
- Effective team leadership
- Deadline-driven task organization
- Collaborative decision-making
Certification
- Certified Case Manager (CCM)
Timeline
Manager II Transplant and Specialty Services
Anthem Blue Cross
01.2022 - Current
Transplant Nurse Lead
Anthem Blue Cross
01.2014 - 01.2022
Senior Specialized Case Manager
Anthem Blue Cross
01.2008 - 01.2014
Care Coordinator
Mercy Clermont Hospital
01.2007 - 01.2008
Case Manager
Brown County General Hospital
01.2005 - 01.2008
Case Manager
Blue Cross Blue Shield of Tennessee
01.2003 - 01.2005
Bachelor of Science -
University of Michigan
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