Summary
Overview
Work History
Education
Skills
Affiliations
Certification
References
Timeline
Generic

Melisa Burns

Tampa,FL

Summary

Detail-oriented Managed Care Coordinator with extensive experience at Elevance Health, specializing in chronic disease management and care plan development. Demonstrated success in improving patient outcomes through strategic care coordination and collaboration across multiple disciplines. Proficient in HEDIS reporting and data analysis, assisting initiatives that enhance process efficiencies while advocating for members’ health needs. Career aspirations include advancing health service delivery models to further elevate patient care standards.

Overview

11
11
years of professional experience
1
1
Certification

Work History

Managed Care Coordinator

Clear Health Alliance
09.2020 - Current
  • Manages members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits
  • Participates in or intradepartmental and cross-functional teams, projects and initiatives, and process improvement activities
  • Provides supervision and direction to non-RN clinicians participating in members' cases, in accordance with applicable case law and contract

Contract Registered Nurse

W3R Consulting
02.2020 - 08.2020
  • Performed medical record reviews for HEDIS to assist in improved performance and compliance
  • Conducted quantitative and qualitative analysis of data to determine interventions for project improvement
  • Completed research in medical records, claims, and various systems to identify data to close gaps in care

Field Case Manager

Aetna
02.2019 - 02.2020
  • Coordinated case management activities for acute and chronically ill members across the continuum of care
  • Assessed medical status and developed care plan for caseload of 50-70 members to assist with self-management
  • Facilitated appropriate condition management and optimized members’ overall wellness and medical outcomes

Remote Case Manager / Wellness Specialist

Magellan Complete Care
06.2014 - 12.2018
  • Managed caseload of up to 150 chronically ill members by promoting effective utilization of health care services
  • Performed electronic medical records reviews, abstraction and data entry for HEDIS measures
  • Worked closely with supervisor and team to evaluate services and monitor outcomes to maximize members’ health

Education

Master of Science - Nursing Education

Oklahoma Wesleyan University
Bartlesville, OK
07-2020

Bachelor of Science - Nursing

Oklahoma Wesleyan University
Bartlesville, OK
06-2018

Associate of Science - Nursing

Broward College
Fort Lauderdale, FL
12-2010

Skills

  • Care coordination
  • Chronic disease management
  • HEDIS reporting / Data analysis
  • Care plan development
  • Patient advocacy
  • Multidisciplinary team collaboration
  • Strong organization
  • Medicare/Medicaid compliance

Affiliations

  • Volunteer at Various Initiatives through Elevance Health
  • Florida Ambassador at Elevance Health
  • Member of the Transformation Network Champions at Elevance Health

Certification

  • Florida Registered Nurse (RN) Multistate/Compact License - # RN9321966
  • Certified Case Manager (CCM) - Certification # 4220379

References

References available upon request.

Timeline

Managed Care Coordinator

Clear Health Alliance
09.2020 - Current

Contract Registered Nurse

W3R Consulting
02.2020 - 08.2020

Field Case Manager

Aetna
02.2019 - 02.2020

Remote Case Manager / Wellness Specialist

Magellan Complete Care
06.2014 - 12.2018

Master of Science - Nursing Education

Oklahoma Wesleyan University

Bachelor of Science - Nursing

Oklahoma Wesleyan University

Associate of Science - Nursing

Broward College

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Melisa Burns