Sherresa Cassey
Richardson
Summary
Career development in setting that requires Registered Nurse (RN) with current, valid, multistate, unrestricted license by the Texas State Board of Nurse Examiners. Also have current, valid, unrestricted RN license in Nevada and Illinois. Use my nursing experience in Case Management and Utilization Management knowledge to be an advocate/resource for patients and family. Provide education/local resource information for self-care, disease management, medications, health and wellness. Background in Labor and Delivery for over a decade. High Risk OB and Maternal Fetal Medicine RN for over 5 years.
Overview
19
19
years of professional experience
Work History
Utilization Management
Health Care Service Corporation/BCBS
Richardson
03.2023 - Current
- Review clinical documentation and EPIC for approval of Inpatient days per MCG guidelines.
- Initial pended and concurrent reviews for IP days.
- Review of clinical documentation for surgery approvals per MCG guidelines/policy.
- Review of clinical documentation for Traditional Home Hospice and Inpatient Hospice days per MCG guidelines.
- Present to Medical Director inpatient stays over 14 days for determination.
- Up to date on current MCG guidelines.
- Yearly updates and testing on MCG guidelines.
- Review for HEDIS measures and report.
- Utilization Management for Federal Employee Program for 5 states, Texas, Illinois, Oklahoma, New Mexico, Montana. Review clinical documentation and EPIC for approval of Inpatient days per MCG guidelines.
TRS Wellbeing Health Advisor
Health Care Service Corporation/Blue Cross Blue Shield
Richardson
07.2020 - 03.2025
- Responsible for performing a variety of functions, single source of contact for members, health care personnel, all other entities involved in managing care.
- Identifies alternate treatment programs; consults with physicians, providers, members, other resources to evaluate options and services required to meet an individual’s health needs.
- Promotes quality and cost-effective outcomes; and serves as liaison to physicians and members.
- Determining member assignment of treatment, and pre-admission/post-discharge counseling for acute condition.
- Establish relationship with the member.
- Handle immediate post discharge follow-up or until all short term care needs are met.
- Provide education/local resource information and encourage member (self) education.
- Functioning in a clinical care advisory role, assesses members for wellness education and disease management.
- Introduces members to our website tools, educates members regarding wellness and specific conditions, and facilitates the coordination of care for identified members.
- Provide oversight to Holistic Health Coordinators.
- Case Management for High Risk OB/NICU dedicated programs along with our HHM.
Wellbeing Health Advisor
Health Care Service Corporation/Blue Cross Blue Shield
Richardson
10.2018 - 07.2020
- Identifies alternate treatment programs; consults with physicians, providers, members, and other resources to evaluate options and services required to meet an individual’s health needs.
- Promotes quality and cost-effective outcomes; and serves as liaison to physicians and members.
- Determining member assignment of treatment, and pre-admission/post-discharge counseling for an acute condition.
- Establish relationship with the member.
- Handle immediate post discharge follow-up or until all short-term care needs are met.
- Provide education/local resource information and encourage member (self) education.
- Functioning in a clinical care advisory role, assesses members for wellness education and disease management.
- Introduces members to our website tools, educates members regarding wellness and specific conditions, and facilitates the coordination of care for identified members.
- Provide oversight to Holistic Health Coordinators.
- Responsible for performing a variety of functions and is a single source of contact for members, health care personnel and all other entities involved in managing care.
Holistic Health Specialist Case Manager
Blue Cross Blue Shield/HCSC
Chicago
01.2018 - 10.2018
- Provide Holistic Health services and resources to our HCSC employees and families at their fingertips.
- Collaborative efforts made to assist members by including Health Advocates, Social Work, BH, UM for co-management.
- Assess member needs/concerns Preadmission and Post Discharge.
- Offer resources to assist member, case management, disease management, assess gaps in core conditions, identify cost savings, educate on disease process, labs, nutrition, medications and preadmit/post discharge instructions given.
- C1 Innovation lab, demonstrations to potential customers such as American Heart Association, Lockton, CAT/Holt.
- Going through phases of design thinking to promote bringing alive new innovative ideas for our customers/members.
- Demonstrating success stories to potential customers.
- Transition of HCSC accounts under Health Advocacy Solutions (HAS) team.
Primary Nurse Case Manager
Blue Cross Blue Shield/HCSC
Chicago
07.2017 - 12.2017
- Offer resources to assist member, case management, disease management, assess gaps in core conditions, identify cost savings, educate on disease process, labs, nutrition, medications and preadmit/post discharge instructions given.
- C1 Innovation lab, working collaboratively with team/POD to produce creative and innovative ideas using design and critical thinking skills.
- Experience with Aerial.
- Assess member needs/concerns preadmission and post discharge.
RN Case Manager CVS OB/High Risk Pregnancy
United Healthcare/Optum
Richardson
11.2015 - 06.2017
- Health assessment to identify risk factors and educating member throughout pregnancy.
- Review of goals with member.
- Educating member on how to reach set short term and long-term goals.
- Management of 200+ maternity cases.
- Maintaining calls to members to follow up and scheduling appointments to keep up with members.
- High risk pregnancy education (diabetes/high blood pressure/thyroid disease/anemia/blood clot disorders/Preterm labor s/s).
- Behavioral Health Screening initial assess in pregnancy and Postpartum Depression screening at 2 and 6 weeks postpartum.
- Engagement with maternity members until 1 year after infant is delivered.
OB/GYN Maternal Fetal Medicine RN
UT Southwestern
Dallas
09.2010 - 11.2015
- Educating patients on medications, s/s to report to OB, health assessment for risk factors, medication review, review of medical conditions, delegate to Patient Care Tech and report to OB/GYN/MFM doctors.
- Call patients with instructions per OB/GYN/MFM on test results.
- Diabetes education.
- Education on management of elevated blood pressure.
- Education and monitoring of high-risk obstetric complications.
- Fetal monitoring in office/review of strip/physician review and sign off.
- Primary Registered Nurse for two Physicians in very busy OB/GYN/Maternal Fetal Medicine office.
Labor/Delivery/Antepartum RN
Baylor University Med Ctr
Dallas
03.2007 - 09.2010
- Provide specialized care for high-risk pregnant women as well as continuously monitoring health of mother with high blood pressure, diabetes, clotting disorders, anemia, thyroid disorders and preterm labor.
- NST and fetal monitoring review.
- Monitoring mom and baby through different phases of labor.
- Report to physician, progress, cervical dilation, non-reassuring FM.
- Education to patients on signs and symptoms to watch for during pregnancy.
- Education on high-risk obstetric complications.
- Antepartum and Labor and Delivery RN.
Education
Associate of Science - Nursing
Southwestern Adventist University
Skills
- Utilization Management
- MCG guidelines
- EPIC
- EPP
- Initial review
- Concurrent review
- Maternity Case Management
- Case Management
- Disease Management
- Holistic Health Management
- C1 Innovation Lab
- NCQA
- HEDIS measures
- Labor and Delivery
- Emergency Response Teams
- Rapid Response
- Charge Registered Nurse
- Staying calm under pressure in high risk situations
- Critical thinking skills
- Customer Service
- Passion for helping people
- High Risk Obstetrics
- Antepartum
- Maternal Fetal Medicine
Specific Skills
- Utilization Management
- MCG guidelines/daily usage/annual MCG guidelines testing
- Use of EPIC/EPP for review of chart to approve for Inpatient days
- Initial and Concurrent review for approval of Inpatient days per MCG guidelines
- UM review for surgeries and Hospice
- Maternity Case Management
- Case/Disease Management
- Holistic Health Management
- C1 Innovation Lab
- NCQA/HEDIS measures/closing gaps in care
- Present to Medical Directors high cost claims/IP stays over 30 days
- Labor and Delivery
- High Risk OB
- Antepartum
- Maternal Fetal Medicine
Timeline
Utilization Management
Health Care Service Corporation/BCBS
03.2023 - Current
TRS Wellbeing Health Advisor
Health Care Service Corporation/Blue Cross Blue Shield
07.2020 - 03.2025
Wellbeing Health Advisor
Health Care Service Corporation/Blue Cross Blue Shield
10.2018 - 07.2020
Holistic Health Specialist Case Manager
Blue Cross Blue Shield/HCSC
01.2018 - 10.2018
Primary Nurse Case Manager
Blue Cross Blue Shield/HCSC
07.2017 - 12.2017
RN Case Manager CVS OB/High Risk Pregnancy
United Healthcare/Optum
11.2015 - 06.2017
OB/GYN Maternal Fetal Medicine RN
UT Southwestern
09.2010 - 11.2015
Labor/Delivery/Antepartum RN
Baylor University Med Ctr
03.2007 - 09.2010
Associate of Science - Nursing
Southwestern Adventist University