Mary Viola RN, BSN
Wall Township,NJ
Summary
Analytical and strategic Registered Nurse with documentation review and quality audit background. Organized, efficient and experienced in project management, case management and health insurance industries.
Overview
19
19
years of professional experience
1
1
Certificate
Work History
Implementation Analyst
Horizon Blue Cross Blue Shield Of NJ
10.2020 - Current
- Lead Medical Cost Action Plan initiatives for the Lab Strategy Team
- Manage multiple priorities while coordinating with cross functional teams to complete projects
- Vetting of potential cost-saving initiatives through research and analytics reports
- Build business cases for MCAP initiatives to present for leadership approval
- Draft reimbursement and administrative policies to be implemented.
- Request data reporting and use results to clarify and represent clinical issues.
- Developed comprehensive training materials to ensure smooth transition and adoption of new systems for end users.
Clinical Vendor Liaison
Horizon Blue Cross Blue Shield Of NJ
10.2016 - 10.2020
- Oversight of vendors performing utilization management and case management services.
- Developed comprehensive vendor performance. metrics, leading to data-driven decision making.
- Conducted regular vendor audits to ensure compliance with industry standards and company policies.
- Coordinated regular vendor meetings to review performance data, identify areas of improvement, and develop corrective action plans if needed.
- Established strong rapport with key vendors through excellent interpersonal skills and proactive problem-solving.
Provider Audit Analyst
Horizon Blue Cross Blue Shield Of NJ
01.2014 - 10.2016
- Identified fraudulent or wasteful activities through meticulous investigation of clinical documentation.
- Supported clinical decision-making by preparing summaries of accurate and up-to-date patient information.
- Facilitated timely insurance claims processing through diligent examination and validation of medical documents.
- Enhanced overall department efficiency by developing and implementing standardized procedures for handling appeals cases.
Complex Case Manager
Horizon Blue Cross Blue Shield Of NJ
08.2011 - 01.2014
- Conducted thorough assessments of client situations, identifying issues, goals, and necessary interventions.
- Achieved positive client outcomes by developing and implementing comprehensive case management plans.
- Coordinated essential services for clients, resulting in improved overall well-being and self sufficiency.
Legal Nurse Consultant
Wolf Law PC
01.2015 - 01.2016
- Reduced workload for legal team members by producing a chronological summary of large volumes of medical records.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
Home Health RN Case Manager
VNA Health Group
03.2010 - 08.2011
- Enhanced patient outcomes by developing personalized care plans and coordinating interdisciplinary team collaboration.
- Reduced hospital readmissions through diligent monitoring of patients'' progress and timely interventions in-home settings.
- Managed complex caseloads efficiently by prioritizing tasks, delegating responsibilities to support staff, and maintaining detailed records.
- Managed a team of home health aides, ensuring efficient allocation of resources and timely service delivery.
Certified Rehabilitation Registered Nurse
Ocean Medical Center
03.2006 - 08.2011
- Patient care on fast-paced acute rehabilitation unit
- Monitored patient progress closely, adjusting treatment plans as necessary based on individual needs and responses.
- Participated in interdisciplinary team meetings for discharge planning.
- Educated patients and their families on rehabilitation processes, managing expectations, and fostering a supportive environment.
Pediatric Registered Nurse
Children's Specialized Hospital Outpatient Clinic
03.2005 - 04.2006
- Monitored vital signs closely during procedures or treatments, intervening swiftly when necessary to maintain patient stability.
- Delivered high-quality patient care consistently, adhering to unit protocols and hospital policies while maintaining a professional demeanor under pressure.
- Collaborated with interdisciplinary teams for comprehensive patient care, resulting in improved overall health outcomes.
Education
Bachelor of Science - Nursing
Kean University
New JerseySkills
- Case Review
- EMR / EHR
- Medical Terminology
- Regulatory Compliance
- Patient Chart Auditing
- HIPAA Requirements
- Data Analysis
- Project Management
- Process Improvement
- Training Development
- Quality Control
Certification
- Compact State RN License
- Certified Case Manager, Commission for Case Manager Certification
Timeline
Implementation Analyst
Horizon Blue Cross Blue Shield Of NJ
10.2020 - Current
Clinical Vendor Liaison
Horizon Blue Cross Blue Shield Of NJ
10.2016 - 10.2020
Legal Nurse Consultant
Wolf Law PC
01.2015 - 01.2016
Provider Audit Analyst
Horizon Blue Cross Blue Shield Of NJ
01.2014 - 10.2016
Complex Case Manager
Horizon Blue Cross Blue Shield Of NJ
08.2011 - 01.2014
Home Health RN Case Manager
VNA Health Group
03.2010 - 08.2011
Certified Rehabilitation Registered Nurse
Ocean Medical Center
03.2006 - 08.2011
Pediatric Registered Nurse
Children's Specialized Hospital Outpatient Clinic
03.2005 - 04.2006
Bachelor of Science - Nursing
Kean University
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