Marianne B. Brown
Monroeville,PA
Summary
Accomplished Registered Nurse seeking a challenging career that will expand my expertise and knowledge in the Health Care industry. Recognized as a leader in program implementation, interpersonal communication skills, critical thinking, and time management skills.
Experienced with patient care coordination, including assessment and planning of individualized care. Utilizes effective communication and organizational skills to ensure continuity of care. Track record of supporting patient needs and improving care processes through teamwork and problem-solving.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Inpatient Care coordinator
Optum/NaviHealth
08.2017 - Current
- Responsible for identifying the appropriate post-acute care setting for member following the acute care episode. Utilize InterQual criteria and NH Predict to determine medical necessity and appropriate authorization
- On-site engagement and collaboration with hospital CM, D/C Planers, Social Workers, & Hospitalists to establish an optimal discharge.
- Engage with patients, families, or caregivers either telephonically or on-site.
- Process post-acute care authorization submissions within 2-hour turnaround time frame
- Assure appropriate referrals are made to the Health Plan, High-Risk Case Manager, and/or community-based services.
- Assure patients’ progress toward discharge goals and assist in resolving barriers.
- Perform Inpatient Rehab Facility (IRF) assessments on patients using clinical skills and appropriate measurement tools, such as nH Predict, nH Outcome, InterQual and CMS criteria, upon admission to IRF and through the patient stays.
- Coordinate peer to peer reviews with Medical Directors.
Care Manager
Aetna
01.2016 - 05.2017
- Responsible for care coordination and health education with targeted members through telephonic engagement with members.
- Develop an individualized plan of care with members that promotes healthy lifestyles, reduces unnecessary ER visits and hospital readmissions.
- Collaborate with patient management team, medical providers, community resources and caregivers to optimize member support.
- Refer members to appropriate health management programs to enhance their knowledge/skills for health and lifestyle management.
Consultant
Medicare Clinical Program Consultant
05.2014 - 01.2016
- Develop relationships with physician providers as part of a Nurse Outreach program.
- Educate provider staff on Medicare programs focused on member compliance and health maintenance.
- Collaborate with the provider to identify and enroll members in appropriate programs.
- Consistently address provider issues; provide ongoing feedback.
- Monitor member progress
QI Coordinator/Clinical Auditor
Coventry/Aetna Healthcare
06.2006 - 05.2014
- Coordinate, schedule and perform on-site physician medical record audits.
- Educate providers on documentation requirement.
- Validate CMS HCC Medicare Risk Adjustment submissions.
- Perform vendor acquired internal medical records audits to ensure accurate coding and clinical documentation.
Plan Representative
Coventry Federal Health plan
01.2008 - 01.2014
- Plan Representative for Coventry Federal Health plan at yearly Federal Benefit Fairs
Concurrent Review Coordinator
Coventry/Aetna Healthcare
02.2006 - 06.2008
- Directs, coordinates, and performs preauthorization, concurrent, and retrospective reviews for inpatient Skilled Nursing
- Collaborate with Medical Director to develop a care plan, recommendations for alternate levels of care.
- Identifies cost-cutting protocols.
- Monitor quality of care.
Acute Dialysis Nurse
Dialysis Clinic Incorporated
06.2000 - 02.2006
- Responsible for chronic/acute hemodialysis treatments at multiple hospitals.
- Educate patients and families on Dialysis process, as well as ongoing ESRD support.
- Conduct continuing education and/or training of acute staff.
- Perform monthly QA reviews.
- Coordinate staff/treatment schedule.
- Weekly on-call assignment.
Education
Associate Degree - Nursing
Community College Allegheny County, Boyce
Education Major - undefined
Pennsylvania State University, New Kensington Campus
Skills
- Comprehensive case coordination
- Process documentation
- Patient knowledge enhancement
- Effective organizational skills
- Effective time management
- Effective communication
- Collaborative teamwork
- Healthcare service coordination
- Proficient in medical terminology
Certification
Registered Nurse, License # RN – 053769 – L
Timeline
Inpatient Care coordinator
Optum/NaviHealth
08.2017 - Current
Care Manager
Aetna
01.2016 - 05.2017
Consultant
Medicare Clinical Program Consultant
05.2014 - 01.2016
Plan Representative
Coventry Federal Health plan
01.2008 - 01.2014
QI Coordinator/Clinical Auditor
Coventry/Aetna Healthcare
06.2006 - 05.2014
Concurrent Review Coordinator
Coventry/Aetna Healthcare
02.2006 - 06.2008
Acute Dialysis Nurse
Dialysis Clinic Incorporated
06.2000 - 02.2006
Education Major - undefined
Pennsylvania State University, New Kensington Campus
Associate Degree - Nursing
Community College Allegheny County, Boyce
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