Maryann Liddy
Lexington,SC
Summary
Accomplished Certified Nurse Case Manager and Utilization Review Specialist dedicated to serving the most complex and fragile members from the very young to the aging chronically ill. Daily interfacing with providers, families, vendors, and physicians to promote cost savings, early discharge, and prevent readmissions. Combined 19 years as a Nurse Case Manager, Utilization Review Specialist, and an additional 21 years in the acute care setting serving across the life span. Expert serving multiple books of business including Medicare, Medicaid, Commercial, and external clients. Smoothly blend hands-on skills with advanced clinical background. Successful at working with all levels of healthcare providers, physicians, clients, administrators and product team to address patient needs. Disciplined, adaptable, self-motivated promoting attention to detail and the drive to resolve issues effectively. Manage high pressure situations calmly.
Overview
39
39
years of professional experience
1
1
Certification
Work History
Concurrent Review Nurse
All's Well for California Alliance for Health
Lexington, SC
05.2022 - Current
- Performs concurrent and retrospective reviews for out of area acute in-patient services using Milliman Care Guidelines and current CCAH policies.
- Collaboration with both internal and external Health Care Teams to ensure timely review, transition in care, and avoid unnecessary re-admissions.
- Utilizes computerized Electronic Health Record (EHR) systems and other records to access for medical necessity review. Additional access to both Stanford and UCSF systems.
Certified Registered Nurse Case Manager
Banyan Medical Sync Virtual Health
Omaha, NE
03.2021 - 04.2022
- Onboard and provide remote virtual services to Managed Service Clients including, but not limited to Sonoma Valley, Marin, Baptist Health, Advent, and Southeastern Health Systems.
- Perform initial, concurrent, and retrospective reviews to determine medical necessity, level of care, and ensure cost-effective outcomes using both MCG and InterQual Criteria.
- Develop appropriate care plans for at-risk individuals and high-risk families to avoid re-admission.
- Coordinate transitions from Acute Care to Rehabilitation, Skilled Nursing Facility, and Home.
- Procure additional resources from diverse providers to develop specified intervention plans for patients and families including, , but not limited to Home Health Care, Palliative, Hospice, State, and Community Resources.
- Remain up to date on various benefit plans, medical policies, and state specific clinical guidelines or criteria.
Kidney Resource Services
Optum
Omaha, NE
01.2012 - 01.2021
- Clinical Operations across the continuum of care for both Chronic Kidney and End Stage Renal Disease patients.
- Lowered costs while improving care quality by coordinating services and collaborating with dedicated healthcare team.
- Triage to assess member's current health status.
- Assess, coordinate and enroll member in appropriate program to best meet member's needs.
- Implement plan of care.
- Monitor effectiveness.
- Health education to assist with self management.
- Treatment decision support.
- Interface with providers.
- Coordinating and closing identified gaps for members and services as needed to avoid readmission.
- Optimized program resource utilization to prevent unnecessary hospital admissions.
- Collaborate with physicians during medical rounds, updated treatment plans, and provided plan of care to patients and families.
Women's Health Services
Optum
Lisle, IL
01.2008 - 01.2012
- Supervisor for Neonatal Resource Services and Congenital Heart Disease Program.
- Met aggressive timelines in the hiring, training, and onboarding of nurses for the Onsite Expansion Project, Mamsi and Oxford client.
- Resolved conflicts promptly among physicians, nurses and other healthcare employees to keep workflows on task.
- Supervised both clinical and administrative staff delivering consistent coaching and mentoring to improve job efficiency.
- Created and implemented policies and procedures.
- Drove process, efficiency and quality improvements.
- Coordinated delivery of exceptional patient care by evaluating workflows and facilitating positive changes.
- Collaborated with multi-disciplinary staff to improve overall patient care and response times.
- Daily interfacing with Product team.
- Actively involved in audit prep, meetings with Product and client.
- Recruited and hired clinical and administrative staff to bolster skills set of already talented team.
Registered Nurse Case Manager
Neonatal Resource Services Optum
Lisle, IL
01.2006 - 01.2008
- Demonstrated ability to manage Complex Neonatal cases.
- Utilization and Inpatient care management.
- Worked with providers, families, vendors, and physicians to promote cost savings, early discharge, and prevent readmissions.
- Developed and implemented appropriate care plans for at-risk individuals and high-risk families.
- Advocated for patients by identifying insurance coverage, communicating care preferences to practitioners and verifying interventions that met patients' treatment goals.
- Informed patients and families of treatment options and at-home care strategies to reduce unnecessary readmission and seamless transition home.
- Obtained recommendations for inpatient or outpatient level of care by discussing cases with Medical Director.Demonstrated ability to manage Complex Neonatal cases.
Utilization Review Registered Nurse
CSI Staffing Services - Temporary
Chicago, IL
09.2005 - 01.2006
- Reviewed patient admissions to determine medical necessity as directed by MCG criteria.
- Managed Acute Care, SNF, and rehabilitation processes.
- Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
- Remained up to date on various benefit plans, medical policies, and state-specific clinical guidelines or criteria.
Registered Nurse Level 3, NICU
NW-CE DuPage, UChicago, Hinsdale, Landstuhl, MR
Chicago, IL
07.1985 - 09.2005
- Twenty-nine years serving in a multitude of staff and leadership roles.
- Primary focus of serving a diverse population in city and surrounding suburbs specifically Level III high-risk neonates and their families.
- Strong ability to precept and mentor new employees.
- Maintained certification for high-risk Neonatal Nursing through National Certification Corporation for the Obstetric, Gynecologic, and Neonatal Nursing Specialties (NCC).
- Hinsdale Lead: Scheduled and supervised a staff of approximately 15
- Landstuhl Army Regional Medical Center: Department of Defense Civilian serving military families and their high-risk neonates.
Education
Bachelor of Science - Nursing
Creighton University
Omaha, NESkills
- Certified Nurse Case Manager
- Utilization Review using MCG and InterQual
- Staff Development and Precepting
- Telephonic Triaging
- Patient Transfers and Transitions
- Chronic Kidney Disease
- End Stage Renal Disease
- Acute and Rehabilitative Care
- Diabetes Management
- Computerized Charting Specialist
- Women's Health
- High Risk Neonates and Families
Certification
- Certified Case Manager (CCMC) since May, 2016
- Compact Registered Nurse in the State of South Carolina pending, Temporary Primary applied
- Additional Active Licenses California #RN95046376, Illinois #041-233944, Nebraska #85440 (previously Compact)
Timeline
Concurrent Review Nurse
All's Well for California Alliance for Health
05.2022 - Current
Certified Registered Nurse Case Manager
Banyan Medical Sync Virtual Health
03.2021 - 04.2022
Kidney Resource Services
Optum
01.2012 - 01.2021
Women's Health Services
Optum
01.2008 - 01.2012
Registered Nurse Case Manager
Neonatal Resource Services Optum
01.2006 - 01.2008
Utilization Review Registered Nurse
CSI Staffing Services - Temporary
09.2005 - 01.2006
Registered Nurse Level 3, NICU
NW-CE DuPage, UChicago, Hinsdale, Landstuhl, MR
07.1985 - 09.2005
Bachelor of Science - Nursing
Creighton University
- Certified Case Manager (CCMC) since May, 2016
- Compact Registered Nurse in the State of South Carolina pending, Temporary Primary applied
- Additional Active Licenses California #RN95046376, Illinois #041-233944, Nebraska #85440 (previously Compact)
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