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
Utilization Review/ Clinical Appeal RN
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
- Trained new nurses and was 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
Timeline
Utilization Review/ Clinical Appeal RN
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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