Tammy Guardiola
Punta Gorda,FL
Overview
31
31
years of professional experience
Work History
Utilization Review Nurse
Humana
Louisville, KY
12.2020 - Current
TRANSPLANT CASE MANAGEMENT, GIOVERNMENT & COMMERCIAL
ANTHEM BLUECROSS/BLUESHIELD
Virginia Beach, VIrginia
11.2019 - 05.2020
Case Manager
Humana Insurance/Humana at Home Division
Based from Louisville Kentucky
07.2008 - 04.2019
- Managed a 40+ caseload of members ranging from duration of months to years
- Attended and engaged in meetings, computer and as well as phone programs, that helped to improve both patient care and efficiency among other case managers
- Worked closely with patients, via phone calls and regularly home visits as well as maintain an active and collaborative team of other Humana Case Managers.
Utilization Review, Quality Care, and Case Management
PrimeCare Insurance
Milwaukee, WI
06.2007 - 06.2008
- Worked as a Case Manager in following of becoming Case Management Certified
- Responsible for assessing inpatient members and coordinating with discharge planner for placement and benefits
- Was a part of Utilization Management for inpatient members and catastrophic cases.
Visiting Nurse
Aurora Home Health Care
Milwaukee, WI
07.2003 - 06.2007
- Worked as a home health nurse for the geriatric and pediatric population specialties
- Worked with patients varying from middle-aged adults to young children
- Responded to multiple responsibilities such as wound care, implementation of doctoral orders, evaluations of both patients' well-being and environmental status.
Quality Assurance and Utilization Review
Aurora Lakeland Hospital
Elkhorn, WI
07.2003 - 06.2007
- Managed multiple members, assisting them through any medical related issues and concerns
- Coordinated with doctors, therapists, and others on their healthcare teams
- Helped to guide personnel working within the company to better their teams and work
- Utilized Milliman guidelines for inpatient, outpatient, and prior authorizations.
Registered Nurse
Children's Hospital of Wisconsin
Milwaukee, WI
01.1993 - 06.2003
- Worked in a variety of inpatient and outpatient setting including telephone triage and urgent care
- Mentored and trained new nurses, assisting them in progressing their skills in the nursing field
- Belonged in multiple active committees that helped to improve patient care.
Education
Masters in HealthCare Administration -
Cardinal Stritch University
06.1998
Bachelors in Science of Nursing -
University of Wisconsin Milwaukee
06.1993
High School Diploma -
Waterford Union High School
06.1988
Skills
- Ability to navigate and problem solve during an intense fast-paced, medical crisis
- Care for both inpatient and outpatient, chronic and acute patients
- Case management for a variety of different medical issues
- Being able to provide and educate patients into having the best medical attention possible
- High collaboration skills ranging from a hospital setting to via phone and computers
Timeline
Utilization Review Nurse
Humana
12.2020 - Current
TRANSPLANT CASE MANAGEMENT, GIOVERNMENT & COMMERCIAL
ANTHEM BLUECROSS/BLUESHIELD
11.2019 - 05.2020
Case Manager
Humana Insurance/Humana at Home Division
07.2008 - 04.2019
Utilization Review, Quality Care, and Case Management
PrimeCare Insurance
06.2007 - 06.2008
Visiting Nurse
Aurora Home Health Care
07.2003 - 06.2007
Quality Assurance and Utilization Review
Aurora Lakeland Hospital
07.2003 - 06.2007
Registered Nurse
Children's Hospital of Wisconsin
01.1993 - 06.2003
Masters in HealthCare Administration -
Cardinal Stritch University
Bachelors in Science of Nursing -
University of Wisconsin Milwaukee
High School Diploma -
Waterford Union High School