Maureen McGuire
Olmsted Falls,OH
Summary
Organized Team Leader builds positive rapport, inspire trust and guide teams toward achievement of organizational goals. Strong facilitator adept at working cross-departmentally with co-management and top-level leadership. Excellent trainer and mentor.
Overview
34
34
years of professional experience
1
1
Certification
Work History
Team lead
CareSource, Health Care Corporation
01.2011 - 12.2023
- Lead, develop and manage a team of 15 direct reports comprised of RN's, licensed Social Workers, LPCC, LPNs and a Lactation consultant.
- Trained new team members by relaying information on company procedures.
- Routine review of reports/dashboards to identify and resolve issues that may adversely impact team efficiencies and productivity
- Active member of leadership discussions/meetings that impact the success of the Maternity program (Job Aid Meetings, Team Huddles, State specific POD meetings.)
- Perform monthly audits and coaching for Case Management staff
Telephonic Case Manager
CorVel Corporation
01.2003 - 01.2011
- Collaborated with injured workers, healthcare providers, employers and the BWC to drive continuity of care.
- Maintained detailed records of patient progress, documentation of services and case notes.
- Performed authorization dispute resolution and bill review functions
- Assigned and handled large accounts.
Prior Authorization Nurse
Cigna
01.2001 - 01.2003
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Reviewed cases using guidelines based on medical necessity and benefit coverage
- Increased productivity by 10% and increased audit results by 30% over a one year period
- Received the Circle of Excellence Award for exceeded department goals
- Negotiated with non contracted providers to obtain more favorable rates for the health plan.
Preauthorization Specialist
The J.P Farley Corporation
01.2000 - 01.2001
- Performed pre-admission, concurrent and retrospective review on inpatient confinements and pre-procedure review of out patient surgical procedures
- Drafted and implemented a faxed form for providers to increase efficiency and reduce provider's downtime
- Managed patient cases on a daily basis ensuring cost savings
- Maintained liaisons with referral sources improving customer service.
- Followed all company policies and procedures to deliver quality work.
Registered Nurse
Aristocrat west skilled nursing facility
01.1997 - 01.2000
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Administered medications to 30 residents via oral, IV, and intramuscular injections and monitored responses.
- Updated patient charts with data such as medications to keep records current and support accurate treatments.
Claims Adjudicator
Massachusetts Mutual
01.1990 - 01.1994
- Knowledge of ICD10 & CPT coding and documentation concepts, guidelines and clinical terminology.
- Collaborated with team members and management to meet goals.
Education
Bachelor of Science - Nursing
Chamberlain University
Downers Grove, ILRN - Nursing
Associate Degree Nursing
BBA - Marketing
Cleveland State University
Cleveland, OHSkills
- Leadership
- Care coordination
- Mentorship
- Manage care knowledge
- Trend Tracking
- Performance Monitoring
- Regulatory Compliance
Certification
- CCM
- Compact RN in Ohio
Timeline
Team lead
CareSource, Health Care Corporation
01.2011 - 12.2023
Telephonic Case Manager
CorVel Corporation
01.2003 - 01.2011
Prior Authorization Nurse
Cigna
01.2001 - 01.2003
Preauthorization Specialist
The J.P Farley Corporation
01.2000 - 01.2001
Registered Nurse
Aristocrat west skilled nursing facility
01.1997 - 01.2000
Claims Adjudicator
Massachusetts Mutual
01.1990 - 01.1994
Bachelor of Science - Nursing
Chamberlain University
RN - Nursing
Associate Degree Nursing
BBA - Marketing
Cleveland State University