Case management of Blue Cross Blue Shield members by assessing member's health care needs and developing individualized plans of care.
Identified barriers to optimal healthcare utilization and developed strategies for overcoming them.
Facilitated discharge planning and transition of care through outreach to the member and collaboration with the healthcare team to maximize the member's benefits and resources.
Conducted outreach activities such as health fairs or workshops in the community and assist in educating facility staff regarding Blue Cross Blue Shield's benefits and processes for prior authorization.
Nurse Case Manager
Florida League of Cities
Orlando, United States
09.2018 - 03.2023
Coordinated and facilitated medical care for injured workers, collaborating with multidisciplinary teams to ensure efficient and effective delivery of healthcare services to expedite a timely return to work.
Coordinated medical treatment and return-to-work programs for injured employees by developing individual plans outlining modified duty assignments or restrictions.
Evaluated workers compensation cases for appropriateness of care, cost effectiveness and compliance with state regulations.
Provided case management services for injured workers throughout the duration of their recovery period.
Maintained up-to-date records of employees' medical histories, illnesses, treatments and vaccinations.
Field Nurse Case Manager
Aggressive Health Solution, LLC.
Coral Springs, FL
08.2008 - 09.2018
Provided field nurse case management services as an independent contractor for worker's compensation claims.
Collaborated with physicians, claims adjusters, vendors, and other healthcare professionals to provide individualized care plans towards maximum medical improvement.
Ensured compliance with all relevant regulations and state worker's compensation guidelines related to case management services.
Coordinated referrals for specialty care or additional services when necessary.
Developed discharge plans for patients transitioning from acute care settings to home environments.
Maintained detailed electronic records of case notes including diagnosis information, treatments provided, medications prescribed, and lost time days.
Nurse Case Manager and Team Supervisor for Field Case Management
Broadspire; A Crawford & Company
Fort Lauderdale, Florida
09.2004 - 09.2008
Responsible for the daily supervision of field nurses.
Actively participated in performance improvement initiatives within the organization.
Collaborated with payers to obtain authorization for requested services when applicable.
Evaluated nursing notes to confirm completeness and accuracy of descriptions outlining nursing care provided and corresponding patient responses.
Utilized business customer service and relationship building skills to consistently increase referrals.
Provided training and support to new employees to ensure they understand their job responsibilities.
Occupational Health Nurse
Motorola Solutions
Schaumburg, Illinois
07.1999 - 06.2004
Managed OSHA record keeping and workman’s compensation claims.
Educated staff on proper safety protocols in order to prevent workplace injuries and illness.
Maintained up-to-date records of employees' medical histories, illnesses, treatments and vaccinations.
Developed strategies for reducing hazards associated with hazardous working conditions or equipment.
Responded to emergency situations such as accidents or illnesses that occur within the work environment.
Organized wellness programs such as smoking cessation classes, weight management seminars and stress reduction activities.
Collaborated with management personnel regarding ergonomic design of workstations to reduce risk of musculoskeletal injury.
Staff Registered Nurse
Advocate Sherman Hospital
Elgin, Illinois
09.1994 - 09.1999
Administered medication and treatments to patients ensuring accuracy and compliance with prescribed orders.
Provided direct patient care, including wound dressing changes, administering medications, injections, and other treatments.
Monitored vital signs of orthopedic and neurological patients and reported any abnormalities to physicians.
Instructed patients on pre-and post-operative care for orthopedic procedures.
Developed treatment plans in collaboration with physicians for orthopedic conditions such as fractures and joint replacements.
Provided education on proper body mechanics to prevent further injury or pain due to improper movement habits.
Performed therapeutic nursing care interventions for patients with neurosurgical and neurological injuries.
Education
Bachelor of Arts - Business Administration And Management
Roosevelt University
Chicago, IL
05-2003
Associate of Applied Science - Registered Nursing/Registered Nurse
Harper College
Palatine, IL
05-1997
Certification
Registered Nurse-Multi State/Compact, incuding Florida and California
Certified Occupational Health Nurse-American Board of Occupational Health Nursing
Timeline
Nurse Navigator
Blue Cross Blue Shield of South Carolina
01.2024 - Current
Nurse Case Manager
Florida League of Cities
09.2018 - 03.2023
Field Nurse Case Manager
Aggressive Health Solution, LLC.
08.2008 - 09.2018
Nurse Case Manager and Team Supervisor for Field Case Management
Broadspire; A Crawford & Company
09.2004 - 09.2008
Occupational Health Nurse
Motorola Solutions
07.1999 - 06.2004
Staff Registered Nurse
Advocate Sherman Hospital
09.1994 - 09.1999
Bachelor of Arts - Business Administration And Management
Roosevelt University
Associate of Applied Science - Registered Nursing/Registered Nurse
Project Administrator for Change Order Management at Blue Cross And Blue Shield Of South CarolinaProject Administrator for Change Order Management at Blue Cross And Blue Shield Of South Carolina
Lead Pharmacy Operations Analyst at Blue Cross & Blue Shield of South CarolinaLead Pharmacy Operations Analyst at Blue Cross & Blue Shield of South Carolina