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Medical Case Manager

Location:
Canonsburg, PA, 15317
Salary:
70,000
Posted:
April 25, 2012

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Resume:

Michelle Blackhurst

*** ******** **.

Canonsburg, Pa. 15317

Home: 724-***-****

Cell: 412-***-****

pqs5xo@r.postjobfree.com

Professional Summary:

A motivated individual with over 11 years of professional experience within the healthcare arena. Throughout my career, I have gained diverse experience in various capacities. Coupled with a Bachelor of Science in Nursing, I possess excellent communication and interpersonal skills.

Education: Duquesne University Pittsburgh, PA

Bachelor of Science in Nursing, 1996

Accomplishments/Rewards:

• “Cameo of Caring” award for Cardiovascular Surgical Unit at St. Clair Hospital in April 2005.

• Elected as Peer Advisory Team President for National Franchise Oogles n Googles™ in April 2007.

• Elected to speak at National Franchise Oogles n Googles™ Retreat in August 2007 and July 2008 – “$0 - $13,000 in 12 months.”

• Personally featured in August 2007 issue of “Entrepreneur Magazine and February 2008 in “Entrepreneur Start-Up Magazine.”

Employment History:

Associates in Rehabilitation 05/10 – Present

Field Nurse Case Manager

• Providing case management services to various employers/insurance companies by assisting them with workman’s compensation and short term disability claims.

• Case Management services involve attending appointments with physicians, physical therapists, hospitals and injured workers to ensure an accepted diagnoses and reasonable and necessary treatment for that diagnosis.

• A self motivated position and required to work in a virtual work environment with detailed billable time.

Travelers Insurance 12/08 to 05/10

Medical Case Manager Workers Compensation

• Office based telephonic medical case management with emphasis on early intervention, return to work planning, coordination of quality medical care on claims involving disability and medical treatment.

• Review medical injury and disease management claim files, injuries and effects of any pre-existing health issues that may affect a patient's recovery.

• Develop medical management strategy and give the provider information necessary to facilitate a return to work plan on claims requiring disability management.

• Work with medical providers and suggest cost effective treatment alternatives.

• Authorize medical treatment and associated diagnostic testing on assigned claims as allowed by state or policy jurisdictions.

• Provide technical assistance and act as a resource for claim handling staff.

• Document all contacts and outcomes related to case activity in computer system.

• Comply with established Best Practices and time sensitive Utilization Review.

Southwestern Pennsylvania Eye Surgery Center 12/07 to 12/08

Registered Nurse – Eye Surgery Center

Caring for patients undergoing eye surgery including cataract removals, plastic surgery and retinal detachment surgery in a recovery room setting.

Oogles n Googles™ 12/05 to Present

Franchise Business Owner/Operator

Own and operate the Pittsburgh franchise for Oogles n Googles™ which provides all inclusive themed birthday parties and preschool enrichment programs for children ages 3 thru 10 years old. Responsible for managing a staff of 6 people, selling enrichment programs to over 20 daycare facilities, and selling over 150 birthday parties.

St. Clair Hospital 8/00 to 02/08

Registered Nurse – Cardiovascular Surgical Unit

Caring for patients recovering from Coronary Artery Bypass Graft surgery in a critical care setting and following the patient through their recovery until discharge.

Registered Nurse – Intensive Care Unit

Caring for critically ill patients including those suffering from Pneumonia, Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, Renal Failure, and Gastrointestinal Bleeding.

Registered Nurse – Inpatient Rehabilitation Unit

Providing rehabilitation nursing to patients recovering from Cerebrovascular Accidents and Orthopedic Surgeries in a sub-acute care setting.

Humana 01/04 to 06/04

Personal Nurse Navigator

Nursing support via phone for Humana members who suffered from recent hospitalization or long term disease in a virtual home office setting.

Allegheny General Hospital 04/00 to 08/00

Registered Nurse – 5B/Surgical Intensive Care Unit

Provided care for those suffering from complications related to Coronary Artery Bypass Graft Surgery in a critical care setting.

Grand Strand Regional 04/98 to 04/00

Registered Nurse/Relief Charge Nurse – Progressive Care Unit

Cared for those recovering from Coronary Bypass Graft Surgery, Cardiac Catheterization, and unstable Angina on a step-down unit.

Health South Mountain View 08/97 to 04/98

Registered Nurse

Provided care for those suffering from traumatic brain injuries in a sub-acute care setting.



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