Teresa Pounds

• Coordinated individualized treatment program for claimant while maximizing cost containment
• Served as intermediary to interpret and educate individual on his/her disability and treatment plan
• Facilitated treatment between providers and workers
• Acted as resource for claims personnel when needing providers in certain locales
• Partnered with employers to determine modified work assignments
• Provided accurate and quality documentation meeting Best Practice time frames
• Reported billing hours in accordance with case activity and billing practices
• Demonstrated level of professionalism within work place and in dealing with injured workers
• Demonstrated ability to save $5,000 or more per claim

• Worked independently and remotely to provide clinical consultation for injured workers in order to direct them to appropriate level of medical care for their injury
• Contacted clinics prior to sending workers to insure would be able to treat injury
• Contacted hospital for any emergent injuries to provide essential information prior to injured worker's arrival
• Worked within state and employer guidelines when providing instructions to injured workers
• Demonstrated ability to triage calls within 15 minutes metric

• Under the direction of the VP of Quality and in collaboration with medical directors assisted with the planning, development, revision, enhancement and standardization of quality programs with the goal of consistency, efficiency and effectiveness for all clinical teams
• Demonstrated problem solving, leadership, conflict management, and team building skills in order to ensure a productive work environment and achievement of goals
• Helped identify skill-specific areas requiring improvement based on audit results and assisted in development of solutions, including adjusting training content, assisting with individual coaching and mentoring
• Assisted in obtaining accreditation with URAC and NCQA
• Acted as a liaison between clinical guideline authors and clinical team
• Served on Quality Committee
• Researched complaints regarding quality of triage
• Served as resource to Non-Clinical Quality Coordinator

Nurse Manager

• Managed remote workforce of 10-12 nurses
• Assisted with training and coaching of new hires
• Quality review of nurse calls to ensure patient safety and customer service
• Responsible for yearly updates to clinical guidelines
• Assisted in the review of new guidelines with guideline authors

Triage Nurse

• Provided telephonic triage and health coaching for adults, pediatric, and obstetric patients
• Answered questions regarding clinical trials for study drugs