Nurse Case Manager Resume
|Desired Industry: Insurance
|Desired Job Location: Aurora, Illinois
||Date Posted: 2/11/2009
|Type of Position: Full-Time Permanent
||Availability Date: Now
||U.S. Work Authorization: Yes
|Job Level: Experienced with over 2 years experience
||Willing to Travel: Yes, Less Than 25%
|Highest Degree Attained: Bachelors
||Willing to Relocate: No
Results driven, with a proven track record as a national leader in indemnity and medical savings. Extensive case management/utilization review experience in negotiating with medical providers; vendors, and communication with claims staff; legal; clinical associates; physicians. Demonstrated adaptability to changes in business need by effectively managing higher caseloads, and provided support with transitional caseloads. Planned, implemented and made enhancements to client-specific transitional return to work programs that resulted in considerable cost savings. Made enhancements to case management workflow, volunteered to develop, test, rollout, train colleagues on new claims/clinical software. Served as a technical resource in mentoring new staff in clinical resources, clinical review policies/procedures. Was a local and national leader in indemnity and cost savings. Consistently achieved above average QA/audit scores.
The Zenith Insurance Company: Lisle, IL
Medical Management Nurse- 2008 to 2009
Worked closely with claims staff to review and facilitate appropriate, timely, and cost effective medical care and disability management on smaller, high-risk accounts.
o Evaluated results of same to either revise strategies or prepare the claims examiner for legal issues on the claim.
Developed new strategies, formulated detailed action plans to elevate medically complex claims for peer review, IME, or legal hearing.
Sedgwick CMS: Chicago, IL
Telephonic Nurse Case Manager Team leader- 2005 to 2008
Averaging 95% or higher on audit scores and a top performer in medical and indemnity savings.
Assist clinical manager in precepting new employees.
Served as technical resource for clinical review policies including preparation for peer review, IME, and software training.
The Hartford Insurance Company/ Specialty Risk Services: Aurora, IL
Telephonic Nurse Case Manager - 2001 to 2005
Daily telephonic coordination of patient medical care and disability management.
On the leading team in the nation in return-to-work management and cost savings.
Central DuPage Hospital- Neurospine Unit: Winfield, IL
Staff Nurse and Relief Charge Nurse - 2001
Direction of postoperative management of patients with orthopaedic spinal surgeries and neurological diseases.
Responsible for staff scheduling, orientation of registry staff, and unit management.
Custom Placement Services: Naperville, IL
Recruiting & Marketing - 2001
Involved in marketing research and expansion of the network database.
Handled development and implementation of new marketing tools and methods of media to promote placement services.
Procured signed fee agreements from potential customers and located qualified candidates to fill these positions.
Wood Glen Pavilion: West Chicago, IL
Marketing & Admissions - 2000 to 2001
Responsible for the development of marketing strategies, promotional events, and advertising support.
Produced and coordinated research/development of amenities to provide a better service to the community.
On-site contacts with potential patients to review medical information, determine medical eligibility, and ensure continuity of care.
Worked periodically as staff nurse in the facility to maintain client/family contact and ensure client satisfaction.
Rosewood Care Centers: Joliet, St. Charles, and Elgin, IL
Marketing & Admissions Coordinator - 1999 to 2000
Achieved well-demonstrated success in the promotion of Rosewood’s services in all 3 locations.
Achieved the highest admission census the facility had ever seen.
Maintained close collaboration with health care providers in the community.
Served as technical consultant to local and regional marketers and served as a representative for Rosewood community events.
Other Clinical Experience:
Good Samaritan Hospital: Downer’s Grove, IL
o Registered Nurse - 1999
Resurrection Medical Center: Chicago, IL
o Registered Nurse/Rehabilitation Team – 1996 - 1999
Valparaiso University – Bachelor of Science in Nursing
RN Licensure in IL, IN, MN, TX, and inactive in FL
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