Ellen Mininberg- BSN, RN

** ******** ****, *******, ** 06010

860-***-**** 860-***-****

acr7y1@r.postjobfree.com

QUALIFICATION SUMMARY蜉

蜉

Comprehensive experience in discharge planning, insurance, Medicare /Medicaid guidelines, case management, utilization/concurrent review, appeals/grievances, disease management and complex care management with insurance companies, acute care facilities, palliative care, SNF, LTACH, and AIR for a multitude of products.

Experience in reviewing clinical notes, hospital charts, office charts, op-reports and radiology reports

Organized and maintained pre-operative clearance needs of both physician and patient, et al; proper ICD-9 and CPT coding and verifications with insurance companies, Medicaid and Medicare. Including patient cost management such as spend down accounts and caps on benefits.

PROFESSIONAL EXPERIENCE

AHH GROUP, AETNA INDSURANCE

Division of company that provides treatment for disabilities due to alcohol or drug abuse.

Case Manager, 2/23/2015 – present

Provide case review for self funded parties such as oncology stroke, head trauma and spinal injury

Family medical leave – Temporary RN management positions which allowed flexible hours and still be caregiver of brother with terminal disease. 07/2013 -2/2015

UNITED HEALTH OXFORD HEALTH PLAN DIVISION AND AARP

Case Manager, 04/2007 - 01/2013.

Onsite and telephonic case management with the goal of safe patient discharge and preventing re-admission by enlisting programs, being part of rounds and forming relationships with other case managers.

Facilitated Concurrent Review, Utilization Review, Appeals, Workman Compensation and discharge planning with a focus on “safe discharge and re-admit prevention.

Handled very complicated disorders, co-morbidities and difficult discharges from hospital to discharge back to work as a workman compensation case.

AETNA INSURANCE

Disease Management, RN Consultant for CAD, Cardiac Ischemia, CVA, Asthma, 12/4/06-4/4/07

Facilitated education of nurses and patients on 30 diseases expanding the teaching for members regarding other diseases such as cancer, heart failure, diabetics, HIV, sickle cell anemia.

Caseload averages 75-100 members.

WELLCARE/PREFERRED ONE

Manager Concurrent Review, New Haven County/ Fairfield County, 3/2005-11/17/06

Handled Asthma Disease Management, Complex Oncology Management which included discharge planning and prior authorization for services and DME. I

Managed cases onsite at Yale New Haven Hospital doing concurrent/ UR/ case management for all lines of business. including the Asthma Disease Program in Connecticut. Attended Asthma Initiative Meetings in the Public Health Department.

Facilitated complex case management for both long term and short-term cases.

FIRST COAST SERVICE OPTIONS, MEDICARE B

Medical Review and Education Nurse, 2002-2004

Handled physician Corrective Action Reviews, appeals, reviewing all pre-pay surgery, concurrent review, claims, pricing, re-openings, utilization review and provider education.

Facilitated local Medicare Review Policy for clinical trial medications for Medicare Part B, and attended CAC conferences where comments from physician and representatives of specialties met quarterly to discuss referrals for fraud.

Reviewed FDA cancer medications related to correct J codes and ICD 9 codes.

HEALTH NET INSURANCE COMPANY. 1998- 4-2002

Coordinated vendors such as Skilled Nursing Facilities, Medicaid and Interqual Criteria systems.

LLOYD STAFFING

Residential Detox program at Liberation House

Staff Nurse, 1997-1999

LLOYD STAFFING, New Haven, CT

Staff Nurse, 1996-1999

Staff relief work at hospitals, nursing homes, home health, supervisor of SNF and private duty.

ANSONIA BOARD OF EDUCATION and EZRA ACADEMY, Woodbridge, CT

School Nurse, 1996-1998

Substitute school nurse for the city of Ansonia and Ezra Academy.

FAMILY HEALTH CENTER AT ST. VINCENT'S MEDICAL CENTER.

Clinic Nurse, 1993 -1994

SURGICAL ASSOCIATES OF WESTPORT

Staff Nurse RN, 1988-1993

PARK CITY HOSPITAL, Bridgeport, CT

Staff Nurse, 1986 -1988

EDUCATION & LICENSURE

B.S., Nursing, 1986, Southern Connecticut State University, New Haven, CT

Scheduled to take the CMC exam for case management.

RN currently licensed in CT

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