Nicole L. Gordon
Palm Harbor
Summary
Dynamic Nurse Case Manager with extensive experience at Coventry Healthcare, excelling in treatment planning and referral coordination. Proven track record in enhancing injured workers' recovery through effective communication and problem-solving skills. Adept at developing return-to-work strategies, ensuring compliance with regulations, and delivering high-quality care outcomes.
Overview
31
31
years of professional experience
1
1
Certification
Work History
Field Nurse Case Manager
Vona Case Management
Palm Harbor
02.2022 - Current
- Coordinated referrals, consultations and therapeutic services for injured employees.
- Monitored injured employees' progress towards established outcomes through continued assessment.
- Coordinated referrals for specialty care or additional services when necessary.
- Assessed and analyzed injured workers' medical and vocational status and needs.
WC Telephonic Nurse Case Manager
Coventry Healthcare
Tampa
10.2012 - Current
- Coordinate appropriate medical care for injured workers.
- Evaluate treatment requests and ensure medical necessity and causal relationship.
- Coordinates a return to work plan with the provider and employer.
- Performs utilization reviews and establishes treatment plans.
Field Nurse Case Manager
Coventry Healthcare/Aetna
Tampa
03.2015 - 02.2022
- Communicates in-person and telephonically with injured workers, medical providers, employers, and claims examiners.
- Ensure a quality product is delivered to customers by staying updated with current statutes and case law.
- Coordinated patient care plans with healthcare providers and families.
- Assessed patient needs through comprehensive evaluations and doctors visits.
- Assessed patient needs through comprehensive evaluations and home visits.
- Educated patients about health conditions and treatment options.
- Conducted follow-up visits to monitor health outcomes and adjust care plans.
- Coordinated referrals, consultations and therapeutic services for injured employees.
- Monitored injured employees' progress towards established outcomes through continued assessment.
Nurse Case Manager
Travelers Insurance
Indianapolis
07.2011 - 10.2012
- Coordinate appropriate medical care for injured workers.
- Evaluate treatment requests and ensure medical necessity and causal relationship.
- Coordinates a return to work plan with the provider and employer.
- Performs utilization reviews and establishes treatment plans.
Registered Nurse
Kindred Healthcare
Carmel
05.2011 - 05.2012
- Assess patients to make suitable nursing interventions.
- Oversee medications and treatments as approved by physician.
- Educate and advise patients of plan of care.
Claims Examiner III
Sedgwick CMS
Tampa
02.2006 - 11.2008
- Investigate, adjust, and settle up to 220 WC claims by determining compensability and ruling out fraud for multiple states including Florida, Georgia, and North Carolina.
Workers Compensation Technical Supervisor/EDI Supervisor
ACE USA
Tampa
02.2005 - 02.2006
- Managed a team consisting of four lost time adjusters by ensuring compliance with Best Practices.
- Assisted the management team with employer recruitment and staffing.
- Provided training and assistance with less seasonal adjusters.
- Attended account meetings and file reviews with team members.
- Resolved EDI state reporting errors and reconciled fines and penalties via the CPS module.
- Ensured office compliance with the administrative code.
Workers Compensation Claims Adjuster
ACE USA
Tampa
12.2000 - 02.2005
- Investigated, adjusted, and settled up to 150 Workers Compensation claims determining disability, identifying fraud, and acting on the company's behalf to provide superior customer service.
- Ensured a quality product is delivered to customers by staying updated with current statutes and case law.
Workers Compensation Claims Adjuster
Atlantic Mutual Insurance
Tampa
04.2000 - 12.2000
- Investigates, adjusts and settles up to 150 Workers Compensation claims per day determining disability, identifying fraud and acting on the company's behalf to provide superior customer service.
- Exhibits strong management abilities in the daily activities of the office inclusive of systems and software expertise as well as solid product knowledge; a patient teacher and trainer.
- Transferred from a Chicago office as a key person to manage the opening of a new office in Tampa.
Automobile/General / Professional Liability Support Technician
Atlantic Mutual Insurance
Chicago
01.1997 - 01.1999
- Audited, monitored and paid legal, medical and indemnity bills.
- Maintained accurate systems codes for claims and documented all file activity.
- Trained departmental co-workers on a new computer system.
Inside Sales Representative
Bearing Distributors
East Chicago
01.1995 - 01.1997
- Built a solid customer base by obtaining new accounts and maintaining existing accounts.
- Tracked all sales orders, purchase orders.
- Provided excellent customer service by utilizing sound follow through techniques.
- Assisted with accounts receivable, collections and accounts payable.
Education
ASSOCIATES IN NURSING - Nursing
INDIANA DABNEY UNIVERSITY
Hammond, Indiana03.2011
American Studies
ECKERD COLLEGE
St. Petersburg, FL01.2008
Business Management
UNIVERSITY OF PHOENIX
Clearwater, Florida01.2005
Business Management
PURDUE UNIVERSITY
Hammond, Indiana01.1998
Skills
- MS Word
- Powerpoint
- Excel
- Workers Compensation Claims
- Treatment planning
- Referral coordination
- Case management
- Return to work strategies
- Effective communication
- Problem solving
- Team collaboration
Areas Of Expertise
- Workers Compensation Claims
- Disability Determination
- Fraud/Subrogation
- Computer Systems Proficient
- Systems Trainer
- Coding
- Automobile/General / Professional Liability
- Legal/Medical/Indemnity Payments
- File Documentation
- WC Board Certified
- Registered Nurse
- Certified Case Manager (CCM)
Special Skills
- MS Word
- Powerpoint
- Excel
- Florida Workers Compensation License
- Certified Emergency Medical Technician
Certification
- Certified Case Manager (CCM)
References
References available upon request.
Timeline
Field Nurse Case Manager
Vona Case Management
02.2022 - Current
Field Nurse Case Manager
Coventry Healthcare/Aetna
03.2015 - 02.2022
WC Telephonic Nurse Case Manager
Coventry Healthcare
10.2012 - Current
Nurse Case Manager
Travelers Insurance
07.2011 - 10.2012
Registered Nurse
Kindred Healthcare
05.2011 - 05.2012
Claims Examiner III
Sedgwick CMS
02.2006 - 11.2008
Workers Compensation Technical Supervisor/EDI Supervisor
ACE USA
02.2005 - 02.2006
Workers Compensation Claims Adjuster
ACE USA
12.2000 - 02.2005
Workers Compensation Claims Adjuster
Atlantic Mutual Insurance
04.2000 - 12.2000
Automobile/General / Professional Liability Support Technician
Atlantic Mutual Insurance
01.1997 - 01.1999
Inside Sales Representative
Bearing Distributors
01.1995 - 01.1997
ASSOCIATES IN NURSING - Nursing
INDIANA DABNEY UNIVERSITY
American Studies
ECKERD COLLEGE
Business Management
UNIVERSITY OF PHOENIX
Business Management
PURDUE UNIVERSITY
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