Vicki Gleason
Buffalo
Summary
Clinical professional with comprehensive expertise in patient care coordination, relationship building, and healthcare services. Proven ability to foster strong team collaboration, ensuring seamless communication and patient satisfaction. Adept at navigating dynamic environments, responding effectively to changing needs, and consistently achieving impactful results. Strong skills in patient advocacy, healthcare administration, and multidisciplinary team integration. Reliable and flexible, known for maintaining high standards and delivering outcomes that exceed expectations.
Overview
29
29
years of professional experience
Work History
Clinical Liaison PAC
CareCentrix
05.2024 - Current
- Assess patient’s needs and eligibility for admission to post-acute settings by reviewing medical records.
- Help coordinate seamless transitions between different care settings while providing education to patients and families.
- Building a rapport and establishing trust with the multidisciplinary team at the facilities to ensure the most optimal outcomes for the patient.
- Analyzed data in relation to length of stay and readmission rate for nursing homes to identify trends and to help implement a course of action geared to compliance.
- Utilized AI generated programs internally
- Facilitated patient transitions to home health services, ensuring seamless care continuity.
- Collaborated with interdisciplinary teams to optimize patient care plans and resource allocation.
- Mentored new Clinical Liaison staff on best practices for patient engagement and service delivery strategies.
- Analyzed trends in patient needs to inform strategic initiatives aimed at service enhancement and growth opportunities.
- Improved overall facility performance by participating in quality improvement initiatives targeting key metrics such as length of stay or patient satisfaction scores.
Case Management
Aetna/CVS
12.2023 - 05.2024
- Utilize experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
- Gather appropriate clinical information and apply to clinical criteria and/or guidelines, policy, procedure and clinical judgment to render coverage determination/recommendation along with providers to facilitate care/treatment.
Pre-authorization
United Healthcare
06.2016 - 12.2022
- Adhere to Health Plan and Medicare/Medicaid policies for decision rationale.
- Extract data from numerous medical records to ensure accurate clinical information has been received.
- Ensure effective communication internally and externally delivering excellent customer service.
- Perform all duties assigned by leadership to support department goals.
- Perform first level reviews and refer to Medical Director staff for escalations.
Case Manager
Putnam Hospital Center
07.2016 - 09.2017
- Assist care team with safe, appropriate plan of discharge for all inpatient admissions.
- Provide payor source with clinical documentation required for payment.
- Utilize MCG and Interqual criteria for appropriateness of admission.
- Attend care team meetings for patients with long length of stay and plans of care.
Registered Nurse/Charge Nurse
Davita Health Care
12.2013 - 04.2017
- Responsible for the planning, implementing, educating, and training new staff about dialysis.
- Management of health status with the help of therapy techniques.
- Observe and analyze patient data, assessments, and reports.
- Make recommendations to Medical Director to optimize patient's treatments and participate in rounds.
- Participate in team meetings for the development and management for short/long term care plans.
Clinical Nurse Case Manager/Utilization Review Point of Care
Manhattan Physician's Group (MPG) Emblem Health
03.2009 - 12.2013
- Provide safe care transition from hospital setting to home or skilled nursing facility.
- Coordinate with multidisciplinary teams to provide members with high-quality, low-cost services for preventable hospitalizations.
- Utilize internal and external resources to engage members in appropriate disease management or mental health needs.
- Work closely with clinic staff to ensure member compliance with appointments and obtain referrals.
- Identify need for assistance regarding care-giver burden.
Charge Nurse, Project Manager
White Plains Dialysis Center
03.2008 - 03.2009
Concurrent Review Nurse
Hip Health Insurance (Emblem Health)
04.2005 - 03.2008
Stamford Hospital
03.2001 - 04.2005
Sunnybrook Medical Center
01.1997 - 03.2001
Education
BSN/MSN -
Excelsior College
01.2026
Associate’s degree - Registered Nurse
Conestoga College
Ontario, Canada01.1996
Skills
- Medical record review
- Patient and family advocacy
- Clinical assessment
- Medical terminology expertise
- Time management abilities
- Interpersonal communication
- Professionalism
- Conflict resolution
- Interpersonal skills
- Task prioritization
- Organized and detail oriented
- Communicating to patients and families
QUALIFICATIONS
Registered Nurse for almost 30 years providing quality patient-centered care in hospitals, private clinics, and insurance company settings. Credentialed and diversely experienced. I possess strong knowledge of Medicare regulations, MCG, Interqual, as well as NCQA guidelines for documentation and compliance.
Timeline
Clinical Liaison PAC
CareCentrix
05.2024 - Current
Case Management
Aetna/CVS
12.2023 - 05.2024
Case Manager
Putnam Hospital Center
07.2016 - 09.2017
Pre-authorization
United Healthcare
06.2016 - 12.2022
Registered Nurse/Charge Nurse
Davita Health Care
12.2013 - 04.2017
Clinical Nurse Case Manager/Utilization Review Point of Care
Manhattan Physician's Group (MPG) Emblem Health
03.2009 - 12.2013
Charge Nurse, Project Manager
White Plains Dialysis Center
03.2008 - 03.2009
Concurrent Review Nurse
Hip Health Insurance (Emblem Health)
04.2005 - 03.2008
Stamford Hospital
03.2001 - 04.2005
Sunnybrook Medical Center
01.1997 - 03.2001
Associate’s degree - Registered Nurse
Conestoga College
BSN/MSN -
Excelsior College