SHERRY J. CADE
Braselton,GA
Summary
Experienced healthcare consultant with deep clinical expertise. Well-versed in cutting-edge strategies for clinical best practices and evidence-based care. Analytical and decisive leader with strong planning, organizational, and communication skills.
Overview
21
21
years of professional experience
Work History
Utilization Management Clinical Consultant
Aetna Atlanta
Atlanta
05.2014 - Current
- Proficiently perform pre-certification, concurrent review, and discharge planning activities for Medicare and commercial membership.
- Successfully provide continuity of care under the One Nurse Model, from the acute to post-acute setting. -Exceeds the departmental productivity metric by consistently completing more than 15 reviews daily.
- Collaborate with Medical Directors to coordinate and provide the appropriate level of care to meet members' health needs, ensuring proper utilization of health services that promote cost-effective care.
- Serve as a preceptor to newly hired team members during the transition to the One Nurse Model.
- Collaborate with healthcare teams to evaluate patient outcomes and develop strategies for improvement.
- Provide guidance on managed care policies and procedures to ensure compliance with regulations.
- Monitor quality performance indicators for utilization review activities related to clinical outcomes, safety, and timeliness.
- Participate in interdisciplinary team meetings to discuss complex cases requiring authorization for specialized services or equipment.
Registered Nurse Case Manager
Aetna
Atlanta, GA
07.2011 - 05.2014
- Assessed, planned, implemented, and evaluated the nursing care plan for each member to ensure they received individualized care for their pre- and post-discharge needs.
- -Scheduled frequent telephonic interviews to assess the patients' needs and identify any gaps in care.
- Educated members on their healthcare benefits and how to effectively utilize them to improve their health outcomes.
- Designated preceptor for newly hired case managers.
- Implemented interventions based on evidence-based practice guidelines while working collaboratively with interdisciplinary teams.
- Participated in team meetings to collaborate on treatment options for complex cases.
Disease Management Nurse Consultant
Aetna
Alpharetta, GA
10.2006 - 07.2011
- Delivered telephonic education on over 30 chronic medical conditions, guiding members in developing personalized care plans for improved health management.
- Provided expertise to Home Depot's designated team of disease management nurses.
- Utilized comprehensive health assessments to pinpoint areas lacking in care and obstacles to adherence of treatment protocols.
- Implemented individualized action plans derived from assessments, incorporating both short-term and long-term goals.
- Collaborated with case management, maternal, and behavioral health professionals to initiate referrals based on clinical appropriateness.
Corrections Nurse
South Carolina Department of Corrections
Columbia, S.C
05.2003 - 05.2006
- Delivered comprehensive ambulatory care to inmates, encompassing medication administration, treatments, phlebotomy, and patient education.
- Implemented established protocols to offer educational resources and nursing care to inmates with positive PPD skin tests for Tuberculosis.
- Held the position of Acting Assistant Head Nurse.
- Conducted assessments for new inmates upon entry to the correctional facility.
- Implemented instructional sessions regarding infection control protocols and procedures for staff members.
Education
Associate Degree in Nursing - Nursing
Midlands Technical College
West Columbia, SC12-2002
Skills
- Aetna Total View (ATV)
- MedCompass
- Electronic Medical Record (EMR)
- Aetna Strategic Desktop (ASD)
- HRP
- SCM Tool
- Quick Base
- Microsoft Word
- Microsoft Excel
- Microsoft PowerPoint
- Microsoft Outlook
- Milliman Care Guidelines
- Critical Thinking
- Time Management
- Accountability
- Collaboration
- Leadership
- Mentorship
Accomplishments
POD lead (am case balancing for 5 nurses in my POD)
CESI Culture Advocate 2022-2023
Covid Testing Initiative during Pandemic 2020
Dragon Pilot
Focus Group for Med Compass Tasking
Completed preceptor training courses 2012,2013, 2014
Timeline
Utilization Management Clinical Consultant
Aetna Atlanta
05.2014 - Current
Registered Nurse Case Manager
Aetna
07.2011 - 05.2014
Disease Management Nurse Consultant
Aetna
10.2006 - 07.2011
Corrections Nurse
South Carolina Department of Corrections
05.2003 - 05.2006
Associate Degree in Nursing - Nursing
Midlands Technical College