Nurse Case Manager - Insurance Resume Search
Nurse Case Manager - Insurance Resume Search
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Nurse Case Manager Resume


Desired Industry: Insurance SpiderID: 24942
Desired Job Location: Aurora, Illinois Date Posted: 2/11/2009
Type of Position: Full-Time Permanent Availability Date: Now
Desired Wage:
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


Objective:
Summary:
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.


Experience:
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


Education:
Valparaiso University – Bachelor of Science in Nursing


Additional Information:
RN Licensure in IL, IN, MN, TX, and inactive in FL


Candidate Contact Information:
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