Organized and dependable professional successful at managing multiple priorities with a positive attitude. Strong communicator with a passion for mentoring others. Operates in high-pressure environments while recommending best resources and courses of action. Ready to help team meet company goals.
Overview
15
15
years of professional experience
Work History
Case Manager
Anthem Bue Cross Blue Shield
09.2014 - 03.2016
Maintained accurate documentation on caseloads of 40-50 clients, ensuring compliance with regulations and confidentiality requirements.
Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
Collaborated with interdisciplinary team to determine timely delivery of services.
Prior Authorization Nurse
Blue Cross Bue Shield Of Georgia
09.2013 - 09.2014
Expedited urgent requests for prior authorization, ensuring timely access to critical medical treatments.
Participated in interdisciplinary team meetings, collaborating with other healthcare professionals to ensure seamless coordination of care for patients requiring prior authorizations.
Conducted thorough reviews of medical records, identifying necessary documentation to support prior authorization requests.
Tracked performance metrics within the department, identifying areas for improvement and implementing targeted interventions as needed, increasing authorization answers by 48% by streamlining processes.
RN Case Manager
WellCare
07.2011 - 07.2012
Provided emotional support to patients coping with chronic illness or end-of-life decisions, fostering resilience during difficult times.
Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
Collaborated closely with physicians to develop individualized treatment.
Mentored new case managers and service coordinators, answering questions, offering opportunities to shadow and observe and explaining basic information about company procedures.
Presented case findings and recommendations to senior management, influencing decisions regarding client services and department operations.
Oncology and Bone Marrow Transplant Nurse
Johns Hopkins All Childrens Hospital
05.2001 - 05.2006
Maintained detailed documentation of all nursing interventions, assessments, and patient education efforts in accordance with hospital policies.
Served as resource for staff development, providing training on oncology nursing best practices and new technologies.
Provided compassionate care for patients undergoing chemotherapy, radiation, and stem cell transplants.
Served as mentor for new staff members, helping them acclimate to unique demands of working with cancer patients undergoing complex treatments.
Oncology and Bone Marrow Transplant Nurse
Johns Hopkins All Childrens Hospital
02.2008 - 05.2011
Maintained detailed documentation of all nursing interventions, assessments, and patient education efforts in accordance with hospital policies.
Served as resource for staff development, providing training on oncology nursing best practices and new technologies.
Provided compassionate care for patients undergoing chemotherapy, radiation, and stem cell transplants.
Served as mentor for new staff members, helping them acclimate to unique demands of working with cancer patients undergoing complex treatments.
Enhanced Customer Care Team Representative at Anthem Blue Cross Blue and Blue ShieldEnhanced Customer Care Team Representative at Anthem Blue Cross Blue and Blue Shield
Customer Service Representative at Anthem Blue Cross Blue Shield/Elevance HealthCustomer Service Representative at Anthem Blue Cross Blue Shield/Elevance Health