Summary
Overview
Work History
Education
Skills
Volunteer
Additional Information
Timeline
Generic

Tracy Main

Winter Garden,Florida

Summary

Smart Utilization Review Nurse considered critical thinker and problem-solver due to dynamic patient care planning and understanding of Medicare guidelines. Known for having great rapport with providers and insurance carriers.

Overview

14
14
years of professional experience

Work History

Licensed Insurance Agent

BuenaVista Financial
10.2022 - Current
  • Sales agent for Medicare, Individual Health Insurance, Employer/Group Benefits, LTC and Life Insurance
  • Leveraged knowledge of company insurance products and services to advise customers on appropriate choices.
  • Attended continuing education courses and workshops to gain additional insurance industry knowledge.
  • Calculated quotes and educated potential clients on insurance options.

Utilization Review Nurse

Humana Insurance Company
05.2011 - 10.2022
  • Evaluation of medical guidelines using Milliman Care Guidelines (MCG) and benefit coverage to determine appropriateness of services
  • Advocate for and coordinate home care and DME per MD orders to facilitate safe discharge home
  • UM team discharge nurse for LTC plan
  • Mentor and train new staff
  • Write policy and procedure for DC planning team and SNF education role
  • Recipient of multiple STAR awards
  • Submitted cases for criteria failures and helped facilitate resolutions and approvals.
  • Served as subject matter resource, SNF team lead for Medicare plan

Director of Admissions and Marketing

Ocoee Health Care Center
08.2009 - 05.2011
  • Continually maintained and improved company's reputation in markets served
  • Supervised marketing and planning activities to exceed prior quarter admissions
  • Built and strengthened strategic relationships with hospital case managers, insurance providers, home care agencies and medical doctors
  • Management of monthly marketing budget
  • Drove marketing efforts thru community outreach, as well as lunch and learn with key hospital staff and referring providers.
  • Developed and implemented promotional and marketing programs.

Education

No Degree - Health Care Administration

Regis University
Denver, CO

Nursing Diploma - Nursing

Traviss Technical Center

Certificate in Managed Care Nursing - Certified Managed Care Nurse

American Association of Managed Care Nurses

Insurance - Insurance

Florida School of Insurance
Florida

Skills

  • Utilization Review
  • Discharge Planning Coordination
  • Interpersonal and Written Communication
  • Marketing Initiatives and Sales Presentation
  • Quality Assurance Requirements
  • Medicare Compliance
  • Professional Relationships
  • Insurance Industry Knowledge

Volunteer

Junior Service League - League Member; Scholarship Committee Member

Community service including cooking/feeding for homeless, at need population

Assist with organization and marking of community events

Fundraising

Presentation of scholarship's for high school students

FCP - Founding member

Responsible for recruitment and coordination of dynamic speakers; social media marketing, community outreach

Orange Executive Board - Assistant Secretary, Chair of Membership Committee

Home Owner's (HOA) Board of Directors - Secretary/Treasurer

Additional Information

WIth over 20 years of experience in the nursing profession, including 11 years as a Managed Care Nurse, I bring a solid knowledge of the industry. In addition, I am a licensed insurance agent. My experience allows me to offer a unique level of expertise to the relationship of healthcare and industry working together.

Timeline

Licensed Insurance Agent

BuenaVista Financial
10.2022 - Current

Utilization Review Nurse

Humana Insurance Company
05.2011 - 10.2022

Director of Admissions and Marketing

Ocoee Health Care Center
08.2009 - 05.2011

No Degree - Health Care Administration

Regis University

Nursing Diploma - Nursing

Traviss Technical Center

Certificate in Managed Care Nursing - Certified Managed Care Nurse

American Association of Managed Care Nurses

Insurance - Insurance

Florida School of Insurance

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Tracy Main