Susan M. Heffner
Toronto,OH
Overview
22
22
years of professional experience
1
1
Certification
Work History
Nurse Case Management Lead Analyst
Cigna
05.2021 - Current
- Company Overview: Work at Home
- Work at Home
- Telephonic Medical/Behavioral coaching calls
- Preference Sensitive Care Certified
- Preceptor Certified
- Collaborate with Supervisors/Team Leads to drive key results
- Collaborate with Internal/External colleagues/vendors
- Ensured compliance with HIPAA regulations when handling sensitive patient information, protecting client privacy at all times.
- Enhanced patient satisfaction by efficiently addressing and resolving healthcare-related inquiries.
- Managed difficult conversations with compassion and professionalism, helping deescalate tense situations while maintaining a focus on finding resolutions.
Registered Nurse-Quality Sustainment Coach
Cigna
06.2017 - 05.2021
- Company Overview: Work at Home
- Collaborate with Supervisors/Team Leads to drive key results
- Performs staff quality reviews to ensure documentation and quality standards
- Provide quality review results and coaching to front line
- Collaborate with front line staff on successes, opportunities and identified gaps
- Ensures the outcomes of any and all quality reviews are being tracked and logged properly into the quality review tools
- Worked with Readiness to prepare for trainings for front line
- Participated in PathFinder
- Lead Team Meetings/Trainings
- Flexibility with frequent change
- Work at Home
Registered Nurse- Med Review & Appeals
Cigna
08.2016 - 06.2017
- Company Overview: Work at Home
- Medical review/consulting for escalated claims & appeals
- Reviewing/Researching claims, provider notes, discharge summaries, etc
- Understand key health information coding concepts, features and benefits (CPT, ICD, and HCPCS)
- Collaborating with MD for claim approval/denial
- Authorizations
- Time Management
- Skilled in multiple systems to complete a med review
- Work at Home
Registered Nurse- Behavioral and Nurse Case Manager
Cigna
09.2010 - 08.2016
- Company Overview: Pittsburgh, PA 15275
- Telephonic medical and behavioral coaching calls
- Authorizations
- Crisis Calls
- Pre and Post op reviews and follow ups
- Preference Sensitive Care Certified
- Assessments
- Preceptor
- Critical Thinking
- Time Management
- Pittsburgh, PA 15275
Registered Nurse
Critchfield Specialty Infusion Group, LLC
08.2009 - 01.2011
- Company Overview: Greensburg, PA 15601
- Specialized in IVIG infusions
- Independent Contractor
- Greensburg, PA 15601
Registered Nurse
Weirton Medical Center
12.2003 - 08.2010
- Company Overview: Weirton, WV 26062
- Two years Medical Surgical Floor
- Three years Psychiatric Health Floor
- One year Float Pull Department
- CPR Certification
- IV experience
- Assessments
- Critical thinking
- Transfusions
- Maintained a safe work environment
- Weirton, WV 26062
Registered Nurse
Trinity Medical Center-West
02.2003 - 12.2003
- Company Overview: Steubenville, OH 43952
- Medical Surgical Floor
- IV experience
- Assessments
- Critical thinking
- Transfusions
- Maintained a safe work environment
- Steubenville, OH 43952
Education
Registered Nurse Diploma -
12.2002
- Preceptor program six weeks on Telemetry & Emergency
- Thirty week Medical Surgical Rotation
- Ohio Multi State Nursing License current
Skills
- Patient care
- Clinical documentation
- Care coordination
- Family support
- Health coaching
- Clinical skills
- Patient confidentiality
- Stress management
- Compassionate care
- Licensed RN
- Licensed by Ohio nursing board (Multi State licensed)
- Nursing assessments
Work Email
Susan.Heffner@CignaHealthCare.com.com
Work Phone
888-244-6293, 336101
Certification
- Registered Nurse License (RN) - State Board of Nursing (Ohio-Multi State)
- Seizure Recognition and First Aid Certification-Epilepsy Foundation (06/23-06/25)
Seizure Recognition and First Aid Certification
https://learn.epilepsy.com/certificates/tlhrdvge9d
Timeline
Nurse Case Management Lead Analyst - Cigna
05.2021 - Current
Registered Nurse-Quality Sustainment Coach - Cigna
06.2017 - 05.2021
Registered Nurse- Med Review & Appeals - Cigna
08.2016 - 06.2017
Registered Nurse- Behavioral and Nurse Case Manager - Cigna
09.2010 - 08.2016
Registered Nurse - Critchfield Specialty Infusion Group, LLC
08.2009 - 01.2011
Registered Nurse - Weirton Medical Center
12.2003 - 08.2010
Registered Nurse - Trinity Medical Center-West
02.2003 - 12.2003
Trinity Health System School of Nursing - Registered Nurse Diploma,
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