Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Sonali Sheelam

Richmond

Summary

Detail-oriented and highly skilled Nurse Case Manager with 4+ years of experience in care coordination, insurance collaboration, and cross-functional healthcare operations. Proven track record of cultivating relationships with payers, patients, and providers. Adept at translating clinical knowledge into strategic solutions and operational efficiency. Seeking to leverage a healthcare foundation in a dynamic Payer Relationship Manager role.

Overview

7
7
years of professional experience
1
1
Certification

Work History

Medical Case Manager- Telephonic

Travelers Insurance
04.2023 - Current
  • Oversaw the care for a high case load of various complex work related injuries in the VA, DC, NC & SC jurisdictions
  • Reduced care costs by decreasing lost time days and focusing on a safe and timely return to work, ensuring optimal patient outcomes and progress in recovery
  • Analyzed data within medical guidelines to identify appropriate treatment plans and return to work targets, using ICD-10, NCCI, and CPT coding
  • Collaborated with adjusters across all offices to adhere to specific jurisdictional guidelines and workflows, being an advocate for injured workers
  • Channeled injured workers to preferred in network vendors and providers to ensure top quality services, reducing overall cost to the payor
  • Coordinated and reviewed medical treatment with various providers to ensure the patient is actively participating in a medically appropriate and necessary treatment plan
  • Educated and supported both injured workers and employers in the workers compensation process regarding all things medical
  • Utilization Review & Prior Authorizations within URAC & state standards for numerous treatments including procedures, diagnostic testing/imaging, DME, plus more
  • Served as the primary liaison for communication with employers, patients, providers, and attorneys in both written and verbal formats.
  • Submit accurate billing documentation on all activities as outlined in established guidelines.
  • Subject matter expert in pharmacy paper bills, running weekly reports to stay within target, reducing the overall cost to the payor

Registered Nurse

Bon Secours Mercy Health
03.2022 - 03.2023
  • Implemented empathetic care for a high workload of up to 7 patients at a time in a very busy Orthopedic/Medical Surgical Unit with a wide range of conditions, injuries and multiple diagnoses. Total care.
  • Significant expertise in focused and holistic assessment, medication administration, telemetry, venipuncture, IV therapy, blood transfusions, triage, intramuscular/subcutaneous injections, mid-line, central line, and wound care, IV drip titration, documentation, order review, and more
  • Stabilized and monitored surgical patients after surgery, evaluating patient's needs and vital signs, making quick decisions when necessary
  • Collaborated with providers, nurse practitioners, and other parties to facilitate optimal care plans, treatment, and discharge using a holistic approach
  • Partnered/Collaborated with different levels of staff on strategic solutions to patient problems and preventing readmission
  • Assessed and evaluated symptoms and utilized hospital protocols to determine appropriate interventions and treatment recommendations for patients
  • Educated patients in simple terms regarding medication interactions, side effects, and dosing
  • Educated patients and families on discharge instructions and recommendations regarding how to manage their acute/ chronic illness/conditions at home
  • Advised patients when to see a doctor or go to the emergency room
  • Differentiated between true medical emergencies versus acute conditions and administered and recommended appropriate interventions to physicians
  • Adheres to privacy, security, and confidentiality of medical chart and patient health information
  • Recognized numerous times for providing extraordinary patient care by patients, managers, and hospital administration
  • Assists patients with empathy and efficiency in order to determine the best course of action to resolve issues

Caregiver

Privately Employed
04.2018 - 03.2020
  • Assisted with activities of daily living in home including but not limited to assessing, bathing, dressing, administering medications (CPAP, nebulizer, oral), measuring vital signs, blood sugar monitoring, and insulin administration
  • Palliative, Hospice, and Post Mortem care

Bank Teller/Customer Service Representative

Sun Trust
04.2019 - 08.2019
  • Deposited customer's money in forms of coins, money orders, cash, and checks, in addition to card transactions
  • Kept the bank clean and organized
  • Created money orders and official checks
  • Secured the cash vault and helped customers with their safety deposit boxes
  • Identified customer's needs and sold appropriate products
  • Balanced the register at the end of the day

Office Assistant

VCU Department of Graphic Design
08.2018 - 05.2019
  • Answered and directed phone calls
  • Performed daily administrative tasks
  • Used microsoft office, excel, and word to correspond scheduled meetings and appointments
  • Responded to department emails, copied and faxed documents
  • Created excel spread sheets of department finances
  • Updated and gathered office data/records in an organized and precise manner
  • Maintained and troubleshooted office equipment

Education

Bachelor of Science - Nursing

Bon Secours Memorial College of Nursing
Richmond, VA
01-2021

Skills

  • Exceptional interpersonal and communication skills
  • Quality improvement
  • Interdisciplinary collaboration
  • Creative thinker with strong analytical skills
  • Ability to solve problems with strategic solutions under pressure
  • Flexible in the face of change

Certification

  • Certified Case Manager (CCMC)
  • Registered Nurse (Compact License)

Timeline

Medical Case Manager- Telephonic

Travelers Insurance
04.2023 - Current

Registered Nurse

Bon Secours Mercy Health
03.2022 - 03.2023

Bank Teller/Customer Service Representative

Sun Trust
04.2019 - 08.2019

Office Assistant

VCU Department of Graphic Design
08.2018 - 05.2019

Caregiver

Privately Employed
04.2018 - 03.2020

Bachelor of Science - Nursing

Bon Secours Memorial College of Nursing

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