Maura Hilbert
Ridgeland,South Carolina
Summary
Self -motivated, efficient, resourceful and reliable. Excellent communication and interpersonal skills. Confident in interactions with individuals at all levels. Resourceful in the completion of tasks with ability to multi-task efficiently. Function effectively as a team player as well as working independently. Possess strong problem solving skills. Excel in fast paced environments.
Overview
15
15
years of professional experience
Work History
Nurse Case Manager Lead Analyst Utilization Review
Cigna
11.2023 - Current
- Conducts pre-certification, inpatient, retrospective, out of network and appropriateness of treatment setting reviews to ensure compliance with applicable criteria.
- Consult with medical directors to ensure medically appropriate, high quality, cost-effective care throughout the medical management process
- Appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits.
- In-depth understanding of healthcare regulations and compliance, and proficient in insurance guidelines and reimbursement processes.
Nurse Case Manager Lead Analyst
Cigna
01.2017 - 11.2023
- Provides comprehensive assessment and utilizes evidenced based guidelines and a proven ability to critically analyze information from the customer and any medical records available.
- Reviews clinical information submitted by providers to appropriate criteria and makes decision to issue a determination or send to physician review
- Maintains HIPPA and State regulations
- Serves as a resource for members calling for assistance.
- Responsible for assisting with pre-certifications during after-hours & follow-up calls on certain symptoms or situations to ensure understanding & safety.
- Provide training to new staff members
Home Health Registered Nurse
Allegheny Health Network
10.2016 - 05.2017
- Educated individuals and families on health education and disease prevention.
- Initiated, coordinated, and insured ongoing communication with the physician and other members of the health care team.
- Provided direct patient care, evaluated outcomes, and adjusted the nursing care process as indicated to ensure optimal patient care
Registered Nurse - Progressive Care Unit
Allegheny Health Network
12.2015 - 10.2016
- Performed thorough individualized assessments.
- Provided a broad range of general nursing care such as feeding tubes, EKG’s, IV and central lines, PO, IM, and IV medication administration, and foley insertion
- Educated patients and their families on disease processes, medications, medical procedures, and other aspects of their care.
Registered Nurse
UPMC Magee Women's Hospital
10.2012 - 07.2015
- Conducted pre-admission interviews in an office setting and communicated any pertinent information with the Nurse Practitioner.
- Collaborate and communicated with the anesthesiologist and surgeon regarding each patient’s plan of care.
Registered Nurse - Progressive Care Unit
Allegheny Health Network
05.2010 - 02.2013
- Performed thorough individualized assessments.
- Provided a broad range of general nursing care such as feeding tubes, EKG’s, IV and central lines, PO, IM, and IV medication administration, and foley insertion
- Educated patients and their families on disease processes, medications, medical procedures, and other aspects of their care.
Education
MBA - Business
Carlow University
Pittsburgh, PA05-2022
Bachelor of Science - Nursing
California University of Pennsylvania
California, PA05.2012
Associate of Science - Nursing
Community College of Allegheny County
Pittsburgh, PA05.2010
Skills
- Mentor new nurses and responsible for training new employees
- Proficient in Microsoft software
- Excellent written and verbal communication skills
- Strong analytic skills
- Over 13 years of experience working in a variety of healthcare environments
- Medical Records Management
- Broad medical terminology knowledge
- Subject Matter Expert
Timeline
Nurse Case Manager Lead Analyst Utilization Review
Cigna
11.2023 - Current
Nurse Case Manager Lead Analyst
Cigna
01.2017 - 11.2023
Home Health Registered Nurse
Allegheny Health Network
10.2016 - 05.2017
Registered Nurse - Progressive Care Unit
Allegheny Health Network
12.2015 - 10.2016
Registered Nurse
UPMC Magee Women's Hospital
10.2012 - 07.2015
Registered Nurse - Progressive Care Unit
Allegheny Health Network
05.2010 - 02.2013
MBA - Business
Carlow University
Bachelor of Science - Nursing
California University of Pennsylvania
Associate of Science - Nursing
Community College of Allegheny County
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