Summary
Overview
Work History
Education
Skills
Licenses
Timeline
Generic

Virginia Papesh

Summary

Collaborative leader with dedication to partnering with coworkers to promote engaged, empowering work culture. Documented strengths in building and maintaining relationships with diverse range of personalities in dynamic, remote work setting.

Overview

23
23
years of professional experience

Work History

Conifer Health Solutions

Personal Health Nurse
05.2021 - Current
  • Manage account using a 4-Prong approach and exceed billable requirement.
  • Use the Conifer Core Values in daily activities with members, coworkers and clients.
  • Complete Personal Health Management assessment incorporating analysis of the clinical claim chart, discussions with member's goals and their physician's assessment and treatment plan.
  • Develop ongoing individualized plan of care with timeframe, reasonable and appropriate individualized outcomes and specific plan interventions.
  • Follow through with interventions and appropriate documentation.

Case Manager Supervisor

American Health Holdings
04.2019 - 05.2021
  • Managed 25 clients spanning from onboarding to maintaining.
  • Lead/coached a team of 25 nurses- provided education and coaching, acting as a resource for the management of my nursing team assigned.
  • Monitored case management nurses activities to ensure compliance with applicable regulations, accreditation standards, policies and procedures, identifying areas of concern or quality improvement.
  • Assisted Leadership in the development of policies and procedures as needed.
  • Completed mid and end of year review performances and provided feedback regarding performance and goals.
  • Assisted in the hiring, onboarding and training of assigned nurses.
  • Assisted in the onboarding of new clients.
  • Prepared reports that analyzed and tracked quality of service and utilization review statistics.
  • Review client invoices and collaborated with clients.
  • Hosted monthly team meetings.
  • Hosted monthly 1 on 1 meeting with nurses.

Case Manager

American Health Holding
01.2017 - 04.2019
  • Assessment of members through the use of clinical information, conduct comprehensive assessments of referred member's needs and determine approach to case resolution and evaluating member's benefit plan and available internal and external programs/services.
  • Utilize influencing/motivational interviewing skills to ensure maximum member engagement to achieve optimal outcomes.
  • Enhancement of Medical Appropriateness and Quality of Care Application and interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and members needs to ensure appropriate administration of benefits.
  • Using holistic approach as well as consult with supervisors, Medical Directors and others to overcome barriers to meeting goals and objectives.
  • Presented cases at team meetings to obtain multidisciplinary review in order to achieve optimal outcomes.
  • Employ negotiation skills to secure appropriate options and services necessary to meet the members benefits and healthcare needs.
  • Monitoring, Evaluation and Documentation of Care by implementing case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
  • Apply assessment techniques to determine member's level of health literacy, technology capabilities, and/or readiness to change.
  • Provide coaching, information and support to empower the member to make ongoing independent medical and healthy lifestyle choices.

Personal Health Nurse

Conifer Health Solutions
05.2009 - 01.2017
  • Personal Health Nurse/Utilization Management Nurse works within a team to move the participant through the continuum of medical management with the goals of facilitating quality health care through the most cost effective means.
  • Using the Personal Health Management process, that is assesses the participant, works with the participant, family and physician to identify problems, establish goals and develop plans of care, coordinates services, educates participants, I am able to empower participants to independently self-manage and to make knowledgeable health care decisions.
  • The UMN component provides utilization review/pre-certification or pre-notifications on various individuals under designated group health contracts.
  • Vast knowledge of Milliman Care Guidelines.

OB Case Manager

Nationwide Better Health, FutureHealth
12.2004 - 05.2009
  • Manage clients, who have been selected through various referral sources: Utilization Review, Nurse Advice Line and self-referral.
  • Notify the client of their eligibility for Better Health individualized case management program, and subsequently enroll them into the program.
  • Manage a case load of diverse client diagnoses by applying the six essential of case management: assessment, planning, implementation, coordination, monitoring, and evaluation.
  • Collect, analyze, and assess pertinent information about individual cases using phone interviews with consumers and their care providers, medical records, claims data, medical insurance benefit information, and other appropriate resources.
  • Establish and maintain complete case records with required documentation.

Life Bridge Health/Sinai Hospital

Labor And Delivery Nurse
01.2001 - 01.2004
  • Labor and Delivery Unit Provide care to women and their newborns during the ante partum, intrapartum, postpartum, and neonatal stages of this important life event.
  • Teaching, monitoring status, and planning for discharge of patient.
  • Collaborate with physicians and other health care providers to provide the best plan of care for each patient.
  • Implement plan of care by monitoring the mother and baby and by teaching patients about their care and topics related to women's health and newborn care.
  • Evaluate the effectiveness of the care plan and modify it as needed to meet the changing needs of the mother, newborn, and family.
  • Provide psychosocial and emotional support to patients and families.
  • Prepare for delivery through monitor set up, catheterization, IV starts, blood draws etc..

Education

Bachelor of Science - Nursing

Johns Hopkins School of Nursing
Baltimore
06.2021

Skills

  • Critical Thinking/Advanced and Complex Problem Solving
  • Seasoned Case Manager with 20 Years of Experience/Technical Expertise 2 years of which were in a leadership role
  • Cultural Diversity Awareness and Bilingual ability
  • Excellent Communication Skills and Organizational Skills
  • Detail Oriented with Multi-tasking and Prioritizing Capabilities
  • Excellence in Autonomous Work Environments
  • Strategic thinking skills
  • Team Player
  • Resiliant
  • Resiliant
  • Ability to build and foster relationships

Licenses

  • RN- Maryland
  • RN- District of Columbia
  • RN- New York
  • RN- Massachusetts

Timeline

Conifer Health Solutions

Personal Health Nurse
05.2021 - Current

Case Manager Supervisor

American Health Holdings
04.2019 - 05.2021

Case Manager

American Health Holding
01.2017 - 04.2019

Personal Health Nurse

Conifer Health Solutions
05.2009 - 01.2017

OB Case Manager

Nationwide Better Health, FutureHealth
12.2004 - 05.2009

Life Bridge Health/Sinai Hospital

Labor And Delivery Nurse
01.2001 - 01.2004

Bachelor of Science - Nursing

Johns Hopkins School of Nursing

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Virginia Papesh