•Case Manager Certified •Facilitated results-oriented, empathetic and professional adult nursing care for over 23 years. •Respect for compliance in all regulated environments while maintaining a clear vision to accomplish the company goals. •Advocated for members to resolve health concerns. •Communicated with all levels of personnel. Skills Include: •Demonstrated computer and internet literacy. •Implemented Medicare, Medicaid, Highmark Medical Policy, Timeliness Guidelines, and Health Effectiveness and Data Information Sets (HEDIS). •Coordinator of care using Interqual and Milliman and Robertson Guidelines. •Applied motivational interviewing techniques. •Traveled to health fairs. The education provided resulted in an ongoing client/corporation relationship. •Documented pertinent diabetic lab results that were reflected favorably by the •National Committee for Quality Assurance (NCQA) during the audit process.

Highlights:

• Case Manager
• computer and Internet literate
• Utilization review experience
• Organized
• CPR certified
• Motivation interviewing techniques
• Chronic condition management
• Leader